Flexible bronchoscopy in adults: Preparation, procedural technique, and complications
- Shaheen Islam, MD, MPH, FCCP
Shaheen Islam, MD, MPH, FCCP
- Ohio State University Medical Center
Bronchoscopy is a procedure that visualizes the tracheobronchial tree by placing an optical instrument inside the airways. Flexible bronchoscopy is used for a growing number of diagnostic and therapeutic indications such that the clinician should be aware of the potential value of this procedure for their patient.
The general principles of patient preparation, as well as the procedural technique and complications of flexible bronchoscopy are reviewed here. The equipment, indications, contraindications, and procedures that can be performed using a flexible bronchoscope are described separately. (See "Flexible bronchoscopy in adults: Overview" and "Flexible bronchoscopy in adults: Indications and contraindications" and "Flexible bronchoscopy in adults: Associated diagnostic and therapeutic procedures".)
Patient selection — Patients should be selected for flexible bronchoscopy after reviewing the history and clinical exam, and carefully weighing the indications and contraindications, which are reviewed in detail separately. (See "Flexible bronchoscopy in adults: Indications and contraindications".)
Patients are generally asked not to eat for at least six hours prior to the procedure and for patients who are intubated, feeding is discontinued for the same period of time.
Informed consent — Once a patient has been selected for flexible bronchoscopy, the clinician should obtain informed consent from the patient or a designated decision maker. This involves discussing the potential complications, benefits, and alternatives of the planned procedure and the type of sedation (moderate versus general anesthesia). Questions should be answered. Implied consent is acceptable when the bronchoscopy is emergent, the patient is incapable of giving consent due to altered mental status, and a surrogate decision maker is unavailable (eg, removal of a foreign body causing life-threatening airway obstruction). In such cases, the clinician should carefully document the reason that the informed consent is not possible and indicate why the emergent procedure is medically necessary. (See "Informed procedural consent" and "Ethics in the intensive care unit: Informed consent".)
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- PRE-PROCEDURAL PREPARATION
- Patient selection
- Informed consent
- Equipment and supplies
- Topical airway anesthesia
- Route of entry
- Pre-procedural universal protocol
- PROCEDURAL TECHNIQUE
- Entering the tracheobronchial tree
- Airway inspection
- Diagnostic and therapeutic procedures
- DOCUMENTATION AND REPORTING
- Hypotension and cardiac arrhythmias
- Hypoxemia and respiratory failure
- POST-PROCEDURE MONITORING
- SUMMARY AND RECOMMENDATIONS