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Flexible bronchoscopy in adults: Preparation, procedural technique, and complications

Shaheen Islam, MD, MPH, FCCP
Section Editor
Praveen N Mathur, MB, BS
Deputy Editor
Geraldine Finlay, MD


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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Literature review current through: Sep 2016. | This topic last updated: Aug 26, 2016.
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  1. La Combe B, Messika J, Labbé V, et al. High-flow nasal oxygen for bronchoalveolar lavage in acute respiratory failure patients. Eur Respir J 2016; 47:1283.
  2. Miyagi K, Haranaga S, Higa F, et al. Implementation of bronchoalveolar lavage using a high-flow nasal cannula in five cases of acute respiratory failure. Respir Investig 2014; 52:310.
  3. Lucangelo U, Vassallo FG, Marras E, et al. High-flow nasal interface improves oxygenation in patients undergoing bronchoscopy. Crit Care Res Pract 2012; 2012:506382.
  4. Simon M, Braune S, Frings D, et al. High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy--a prospective randomised trial. Crit Care 2014; 18:712.
  5. Esquinas A, Zuil M, Scala R, Chiner E. Bronchoscopy during non-invasive mechanical ventilation: a review of techniques and procedures. Arch Bronconeumol 2013; 49:105.
  6. Heunks LM, de Bruin CJ, van der Hoeven JG, van der Heijden HF. Non-invasive mechanical ventilation for diagnostic bronchoscopy using a new face mask: an observational feasibility study. Intensive Care Med 2010; 36:143.
  7. Wahidi MM, Jain P, Jantz M, et al. American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. Chest 2011; 140:1342.
  8. Grendelmeier P, Tamm M, Pflimlin E, Stolz D. Propofol sedation for flexible bronchoscopy: a randomised, noninferiority trial. Eur Respir J 2014; 43:591.
  9. Pue CA, Pacht ER. Complications of fiberoptic bronchoscopy at a university hospital. Chest 1995; 107:430.
  10. Jin F, Mu D, Chu D, et al. Severe complications of bronchoscopy. Respiration 2008; 76:429.
  11. Facciolongo N, Patelli M, Gasparini S, et al. Incidence of complications in bronchoscopy. Multicentre prospective study of 20,986 bronchoscopies. Monaldi Arch Chest Dis 2009; 71:8.
  12. Carr IM, Koegelenberg CF, von Groote-Bidlingmaier F, et al. Blood loss during flexible bronchoscopy: a prospective observational study. Respiration 2012; 84:312.
  13. Tukey MH, Wiener RS. Population-based estimates of transbronchial lung biopsy utilization and complications. Respir Med 2012; 106:1559.
  14. Ost DE, Ernst A, Lei X, et al. Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med 2016; 193:68.
  15. Eapen GA, Shah AM, Lei X, et al. Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: Results of the AQuIRE registry. Chest 2013; 143:1044.
  16. Ernst A, Eberhardt R, Wahidi M, et al. Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans. Chest 2006; 129:734.
  17. Schnabel RM, van der Velden K, Osinski A, et al. Clinical course and complications following diagnostic bronchoalveolar lavage in critically ill mechanically ventilated patients. BMC Pulm Med 2015; 15:107.
  18. de Blic J, Marchac V, Scheinmann P. Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures. Eur Respir J 2002; 20:1271.