Principles of Performing Fibreoptic Bronchoscopy and Broncho-alveolar Lavage in the Intubated Patient

5.1.4 - Principles of Performing Fibreoptic Bronchoscopy and Broncho-alveolar Lavage in the Intubated Patient

from Section 5.1 - Practical Respiratory System

Published online by Cambridge University Press: 27 July 2023

Nicola Rowe and

Edited by

Debashish Dutta and

Ned Gilbert-Kawai: Affiliation:
The Royal Liverpool Hospital
Debashish Dutta: Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann: Affiliation:
Royal Berkshire Hospital, Reading

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Summary

Key Learning Points

1. Fibreoptic bronchoscopy (FOB) is generally a safe procedure that is performed at the bedside in the ICU, thus avoiding potentially dangerous transfers out of the ICU.
2. FOB is utilised for both diagnostic and therapeutic purposes.
3. FOB-guided broncho-alveolar lavage (BAL) and protected brush specimen (PSB) are extremely valuable procedures and have a high diagnostic yield in identification of the causative organism in pneumonia.
4. FOB is increasingly used in managing difficult airway and in inserting percutaneous tracheostomy devices.
5. In intubated patients, FOB increases airway resistance during the procedure. This causes an increase in the peak inspiratory pressure (PIP) and peak end-expiratory pressure (PEEP), which may result in barotrauma.

Keywords

fibreoptic bronchoscopy broncho-alveolar lavage respiratory

Type: Chapter
Information: Intensive Care Medicine
The Essential Guide
, pp. 534 - 537

DOI: https://doi.org/10.1017/9781108989060 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2021

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References

References and Further Reading

Bonella, F, Ohshimo, S, Bauer, P, Guzman, J, Costabel, U. Bronchoalveolar lavage. Eur Respir Mon 2010;48:59–72.Google Scholar

Bonnet, M, Monteiro, MB. Fiberoptic bronchoscopy in intensive care—particular aspects. Rev Port Med Int 2003;12:17–19.Google Scholar

Liebler, JM, Markin, CJ. Fiberoptic bronchoscopy for diagnosis and treatment. Crit Care Clin 2000;16:83–100.CrossRef Google Scholar PubMed

Marini, J, Pierson, D, Hudson, L. Acute lobar atelectasis: a prospective comparison of fiberoptic bronchoscopy and respiratory therapy. Am Rev Respir Dis 1979;119:971–8.Google Scholar PubMed

Raoof, S, Mehrishi, S, Prakash, UB. Role of bronchoscopy in modern medical intensive care unit. Clin Chest Med 2001;22:241–61.CrossRef Google Scholar PubMed

Tai, DYH. Bronchoscopy in the intensive care unit (ICU). Ann Acad Med Singapore 1998;27:552–9.Google Scholar PubMed