
Contents
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History of Bronchoscopy in Intensive Care History of Bronchoscopy in Intensive Care
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Equipment Equipment
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Indications Indications
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Infection—Pneumonia Infection—Pneumonia
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Ventilator-associated Pneumonia (VAP) Ventilator-associated Pneumonia (VAP)
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Immunocompromised Host Immunocompromised Host
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Airway Assessment and Management Airway Assessment and Management
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Lobar Collapse Lobar Collapse
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Foreign Body Removal Foreign Body Removal
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Burn Inhalation Injury (BII) Burn Inhalation Injury (BII)
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Tracheobronchial Injury/Trauma Tracheobronchial Injury/Trauma
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Transbronchial Diagnostic Sampling Transbronchial Diagnostic Sampling
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Artificial Airway Assistance Artificial Airway Assistance
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Difficult Airway Difficult Airway
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Percutaneous Tracheostomy Percutaneous Tracheostomy
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Airway Haemorrhage Airway Haemorrhage
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Other Indications Other Indications
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Pneumothorax, Air Leak, and Resolution Pneumothorax, Air Leak, and Resolution
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Stents and Tracheo-oesophageal Fistulae Stents and Tracheo-oesophageal Fistulae
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Physiological Effects and Complications of Bronchoscopy Physiological Effects and Complications of Bronchoscopy
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Physiological Effects of Bronchoscopy Physiological Effects of Bronchoscopy
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Complications Complications
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Preparation, Safety, and Procedure Preparation, Safety, and Procedure
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Infection Control Infection Control
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Bronchoscopy in Special Circumstances Bronchoscopy in Special Circumstances
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The Non-intubated Patient (NIV and High Flow) The Non-intubated Patient (NIV and High Flow)
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Bronchoscopy During COVID-19 Bronchoscopy During COVID-19
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Training Training
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References References
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19 Bronchoscopy in Critical Care
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Published:October 2023
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Abstract
Summary
Bronchoscopy in the intensive care unit was developed in the early 1970s. Its flexibility and versatility provide diagnostic and therapeutic value. Common indications are to facilitate placement of a definitive airway, airway sampling for infection, and clearance of secretions. More complex situations such as airway haemorrhage, percutaneous tracheostomy insertion, foreign body removal, burn inhalation injury, tracheal tears, and persistent air leaks in mechanically ventilated patients are amenable to diagnostic and therapeutic bronchoscopy. However, published evidence is limited, and when available does not necessarily demonstrate overall benefit of bronchoscopy in intensive care. Single-use disposable bronchoscopes are increasingly important in the acute. care setting, where a quick set up, rapid visualization, and avoidance of contamination are intrinsic advantages. Further, the quality of optics is approaching that of the standard of reusable bronchoscopes. Bronchoscopy of the acutely sick awake patient is a valuable skill, requiring expertise and experience. A working understanding of endobronchial anatomy, physiological effects, and risks and complications of bronchoscopy in this setting is necessary. Bronchoscopy in the intensive care unit is safe, although well-known complications such as hypoxaemia, hypotension, cardiac arrhythmias, and pneumothorax must be anticipated. Simulated training is shown to improve patient-related outcomes, while offering an understanding of ventilatory physiological changes peri-procedurally. Protocols for preparation, documentation, and World Health Organization–style surgical ‘timeouts’ should be encouraged. Training programmes still require significant development to ensure maintenance of satisfactory contextual and experiential skills and competencies.
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