Diagnostic and Therapeutic Bronchoscopy

Since its early practice, bronchoscopy has evolved into a relatively safe and widely performed procedure that is performed commonly in the intensive care unit (ICU) by both physicians and advanced practice providers. Flexible bronchoscopy which is the most common type of bronchoscopy performed in the ICU will be discussed in depth in this chapter. Flexible bronchoscopy is generally performed with conscious sedation and is used to visualize the trachea, proximal airways, and segmental airways. Indications for therapeutic and diagnostic bronchoscopy will be discussed, as well as contraindications for the procedure. In preparation for bronchoscopy, the provider must first consider the airway for the patient in regard to the optimal mode of entry of the bronchoscope. The provider must then consider the equipment necessary to successfully perform the procedure. We will focus our discussion on flexible bronchoscopy since this is the most widely used in the ICU setting. Necessary preparations must be taken before the procedure which include appropriate monitoring of the patient and having appropriate personnel present for the procedure such as nursing, respiratory therapy, anesthesia, etc. Other considerations must be made while considering the patient’s airway such as necessary equipment, premedication, sedation, and mechanical ventilation. Entering the tracheobronchial tree and airway inspection are the first and most crucial steps when performing bronchoscopy. Specimen may be collected either by bronchoalveolar lavage (BAL) or bronchial brushing for microbial analysis. Patients must be appropriately monitored after bronchoscopy to minimize complications.