Uses of FlexibleFiberoptic Bronchoscopy in I.C.U

Abstract

Bronchoscopy is a fundamental technique used in the study of respiratory diseases. It provides visualization of the upper airway and initial divisions of the tracheobronchial tree and allows for samples to be taken from the trachea, bronchi, mediastinum and lung parenchyma. Furthermore, it is essential in the therapeutic management of patients with hemoptysis, aspiration of a foreign body, excess secretions, neoplastic lesions and obstruction of the central airway. Respiratory involvement is common in the critically ill patient in the intensive care unit (ICU) with 30-50% of the admissions requiring the use of mechanical ventilation. FFB remains a very valuable tool in the evaluation and management of these patients as well as to evaluate complications of mechanical ventilation especially atelectasis and VAP. Bronchoscopy in the ICU plays a role as a diagnostic and therapeutic tool. Bronchoscopy can establish the diagnosis in many of the infections as well as in non-infectious etiologies like acute eosinophilic pneumonia, diffuse alveolar hemorrhage or damage, pulmonary alveolar proteinosis, lipoid pneumonia, eosinophilic granulomas, and rarely rapidly progressing neoplasms. The use of TBBx can add additional diagnosis in selected patients. Fiberoptic intubation is a key aspect in the management of difficult intubations and forms part of several difficult airway algorithms. Intubation in these instances is performed using the bronchoscope as an obturator. Care must be taken to use a bite guard or an oral airway as damage to the scope by patient bite.