Flexible Fiberoptic Bronchoscopy in the Critically Ill Patient

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Abstract
Flexible fiberoptic bronchoscopy (FFB) was used in a high risk group of patients treated in the Intensive Care Unit (ICU) of Presbyterian University Hospital in Pittsburgh. Regional atelectasis on the basis of retained secretions regressed in 78% of trials following FFB and many valuable diagnoses of airway pathology were obtained. The bronchofiberscope inserted transnasally without previous intubation did not significantly interfere with intratracheal pressure changes and alveolar ventilation during spontaneous breathing. However, the instrument caused high positive end expiratory pressures (PEEP) when inserted through tracheal tubes of 7.5 mm internal diameter (I.D.) or less in patients on volume controlled ventilation. This effect could be pronounced enough to cause mediastinal emphysema and probably tension pneumothorax. Suction applied through the channel of the bronchofiberscope caused decreased oxygenation both in patients who maintained spontaneous ventilation and in those maintained on volume controlled ventilation during FFB. Adequate airway, 100% oxygen ventilation during the procedure, and good patient cooperation or relaxation was important for diminishing the risk of potential complications.