Recognize
Common ICU indications include mucus-plug atelectasis, airway obstruction, hemoptysis localization/control, foreign body, difficult airway assessment and lower-respiratory sampling in selected immunocompromised or nonresolving infections.
respiratory
Bronchoscopy in the ICU — Bedside Problem
Safe diagnostic and therapeutic bronchoscopy in hypoxemic, mechanically ventilated and bleeding ICU patients
Act
In intubated patients, use an adequately sized ETT, increase FiO2 as needed, monitor pressures/volumes and minimize suction time. Bronchoscope insertion reduces effective airway lumen and may cause derecruitment, hypercapnia and auto-PEEP.
Escalate
Reassess oxygenation, ventilation, bronchospasm, bleeding, pneumothorax risk after biopsy, sedation effects and hemodynamics. Document specimens and how results will change therapy.
Evidence status
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