Bronchoscopy in the Critical-Care Unit
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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Temporal Trends and Variation in Bronchoscopy Use for Acute Respiratory Failure in the United States
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