Bronchoscopy

Flexible bronchoscopes facilitate airway visualization and documentation of findings (see table Indications for Flexible Fiberoptic Bronchoscopy Indications for Flexible Fiberoptic Bronchoscopy ).

Diagnostically, flexible fiberoptic bronchoscopy allows for

Therapeutic uses include

Rigid bronchoscopy is now used only when a wider aperture and channels are required for better visualization and instrumentation, such as when

Absolute contraindications to bronchoscopy include

Relative contraindications to bronchoscopy include

Transbronchial biopsy should be done with caution in patients with uremia, superior vena cava obstruction, or pulmonary hypertension because of increased risk of bleeding. Inspection of the airways is safe in these patients, however.

Bronchoscopy should be done only by a pulmonologist or trained surgeon in a monitored setting, typically a bronchoscopy suite, operating room, or intensive care unit.

Patients should receive nothing by mouth for at least 6 hours before bronchoscopy and have IV access, intermittent blood pressure monitoring, continuous pulse oximetry, and cardiac monitoring. Supplemental oxygen should be used.

Patients usually receive conscious sedation with short-acting benzodiazepines, opioids, or both before the procedure to decrease anxiety, discomfort, and cough. In some centers, general anesthesia (eg, deep sedation with propofol and airway control via endotracheal intubation or use of a laryngeal mask airway) is commonly used before bronchoscopy.

The pharynx and vocal cords are anesthetized with nebulized or aerosolized lidocaine (1 or 2%, to a maximum of 250 to 300 mg for a 70-kg patient). The bronchoscope is lubricated and passed either through the nostril, the mouth with use of an oral airway or bite block, or an artificial airway such as an endotracheal tube. After inspecting the nasopharynx and larynx, the clinician passes the bronchoscope through the vocal cords during inspiration, into the trachea and then further distally into the bronchi.

Several ancillary procedures can be done as needed, with or without fluoroscopic guidance:

Patients are typically given supplemental oxygen and observed for 2 to 4 hours after the procedure. Return of a gag reflex and maintenance of oxygen saturation when not receiving supplemental oxygen are the two primary indices of recovery.

Standard practice is to obtain a posteroanterior chest x-ray after transbronchial lung biopsy to exclude pneumothorax Pneumothorax Pneumothorax is air in the pleural space causing partial or complete lung collapse. Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical... read more .

Serious complications are uncommon; minor bleeding from a biopsy site and fever occur in 10 to 15% of patients. Patients may have an increase in cough after bronchoalveolar lavage. Rarely, topical anesthesia causes laryngospasm, bronchospasm, seizures, or cardiac arrhythmias or arrest.

Bronchoscopy itself may cause

Mortality is 1 to 4/10,000 patients. The elderly and patients with serious comorbidities (severe chronic obstructive pulmonary disease [COPD], coronary artery disease, pneumonia with hypoxemia, advanced cancers, mental dysfunction) are at greatest risk.

Transbronchial biopsy can cause pneumothorax (2 to 5%), significant hemorrhage (1 to 1.5%), or death (0.1%), but doing the procedure can often avoid the need for thoracotomy Thoracotomy Thoracotomy is surgical opening of the chest. It is done to evaluate and treat pulmonary problems when noninvasive procedures are nondiagnostic or unlikely to be definitive. The principal indications... read more .