Elsevier

Mayo Clinic Proceedings

Volume 64, Issue 10, October 1989, Pages 1255-1263
Mayo Clinic Proceedings

Bronchoscopy in the Critical-Care Unit

https://doi.org/10.1016/S0025-6196(12)61288-9Get rights and content

To determine the diagnostic and therapeutic usefulness as well as safety of flexible fiberoptic bronchoscopy (FFB) in patients admitted to the critical-care unit (CCU), we conducted a review of all such procedures done in our CCU from 1985 to 1988. A total of 129 patients underwent 198 FFB, of which 76% were in mechanically ventilated patients. FFB was done for diagnostic purposes in 87, for therapeutic purposes in 93, and for both reasons in 18. Of the 71 diagnostic FFB performed for cultures, 27 (38%) were positive but only 18 (25%) influenced patient management. An additional 25 FFB were helpful in making therapeutic decisions even though the cultures were negative. Ten of 13 FFB performed for evaluation of airways and 1 of 3 done for hemoptysis were helpful. Of the 90 FFB done because of retained secretions, 37 (41%) showed mucous plugs or significant secretions, but clinical improvement was noted in only 17 (19%). Overall, FFB contributed substantially to patient management in 82 of the 198 procedures (41%). Seven patients had transient complications, but no deaths occurred. We conclude that FFB is safe and can be helpful in the CCU setting.

Section snippets

MATERIAL AND METHODS

We retrospectively studied our experience with bedside FFB during a 3-year period (1985 to 1988) in the 13 critical- or intensive-care units of the Mayo Medical Center in Rochester, Minnesota. The two affiliated hospitals have a combined CCU bed capacity of 171. Although many critically ill patients underwent bronchoscopy in the operating room, only those who had bronchoscopy performed in the CCU were included in this review. During the same period (1985 to 1988), 7,310 FFB were performed at

RESULTS

FFB was performed in 129 patients on 198 occasions. The mean age of the patients was 59.8 years (range, 3 to 90 years). Four patients were younger than 10 years old. The mean duration of stay in the CCU before bronchoscopy was 7.9 days (range, 3 hours to 53 days). The indications for admission to the CCU and underlying medical illnesses (not necessarily the reason for admission to the CCU) are listed in Table 1, Table 2. The major indications for admission to the CCU were respiratory failure

DISCUSSION

Although mobile bronchoscopy carts and respiratory therapists trained in the use of this equipment are available in our CCU, many of the patients admitted to the CCU still undergo bronchoscopy in the operating room. The reason for this preference is the availability of biplane fluoroscopy for transbronchoscopic lung biopsy, rigid bronchoscopic instruments should the need arise, and anesthesiologists and paramedical staff equipped to manage serious complications. The patients described in this

CONCLUSION

Our study shows that FFB is a safe procedure to perform in critically ill patients and that it often results in substantial changes in management of immunocompromised patients, even though it may not ultimately change the outcome. In immunocompromised patients, BAL alone seems adequate for obtaining specimens for culture. FFB is useful for removal of secretions, airway evaluation, and endotracheal intubation. The safety of FFB is no indication for routine use of this procedure for retained

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