Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Introduction
- Classification of Devices
- Fixed-Performance Devices
- Variable Performance Devices
- Introduction: The 4th National Audit Project
- Anatomy
- Approaches
- Difficult Airway Society’s Recommended Technique
- Introduction: NAP4
- How to Predict an Anatomically Difficult Airway
- Equipment
- Difficult Airway Society Guidelines and Airway Management in Critically Ill Adults
- Tracheostomy difficulties
- Introduction
- Indications for Bronchoscopy in the ICU
- Contraindications
- Procedure
- Complications
- Conclusion
- Introduction
- Pre-procedural Considerations
- Procedure
- Post-procedure
- Acknowledgements
- Introduction
- Indications
- Contraindications (Relative)
- Technique for Insertion
- Drainage Bottles
- Pneumothorax Management
- Analysis of Fluid
- Complications
- Introduction
- Diagnosis of Acute Respiratory Failure
- Ultrasound in the Role of Weaning from Mechanical Ventilation
- Pleural Effusions
- Distinguishing Atelectasis from Pneumonia
- Ultrasound to Distinguish ARDS from Cardiac Pulmonary Oedema
- Introduction
- Spirometry
- Inspiratory and Expiratory Flow–Volume Loops in Upper Airway Obstruction
- Bronchodilator Response and Reversibility
- Lung Volumes
- Disease Patterns
- Gas Transfer
- Indications
- Contraindications to Line Insertion
- Risks/Complications
- Potential Insertion Sites
- Allen’s Test
- Procedure
- Introduction
- Localisation of Vasculature
- Techniques for Ultrasound-Guided Peripheral Vascular Access
- Introduction
- Indications
- Contraindications
- Complications
- Ultrasound
- Sites
- Procedure
- Confirmation of Line Placement
- Arterial Puncture
- Introduction
- Equipment Components
- Procedure
- Interpretation
- Clinical Use of Pulmonary Artery Catheters
- Complications
- Introduction
- Pad Positions
- Defibrillation
- Summary of Defibrillation Protocol in Advanced Life Support
- Optimising Defibrillation
- Oxygen
- Drugs in Defibrillation
- Energy Levels
- Implantable Cardioverter–Defibrillators
- Cardioversion outside the Cardiac Arrest Situation
- Complications
- Introduction
- Temporary
- Permanent Transvenous
- Miscellaneous
- Basic Pacing Concepts – Sensing and Capture
- Modes of Operation
- Management of Temporary Systems in the ICU
- Management of Permanent Systems in the ICU
- Pathophysiology of Cardiac Tamponade
- Aetiology of Pericardial Effusion
- Diagnosis
- Indications for Pericardiocentesis
- Contraindications of Pericardiocentesis
- Procedure
- Complications of Pericardiocentesis
- Introduction
- Pulmonary Artery Catheters
- Transoesophageal Echocardiography
- Doppler Devices
- Pulse Pressure Analysis
- Non-invasive Techniques
- Research Tools
- Introduction
- Lead placement and FICE views
- The Essence of FICE
- Common Pathologies Identified
- Acknowledgements
- Introduction
- Indications
- Contraindications
- Lumbar Punctures in the Emergency Setting
- Equipment and Technique
- Samples to Send
- Interpreting Results in Suspected Meningitis
- Complications
- Introduction
- Indications
- Anatomy, Physiology and Pharmacology
- Epidural Regimes
- Assessment and Monitoring
- Troubleshooting
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Volume Replacement
- Analysis of Fluid
- Complications
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Aftercare
- Complications
- Introduction
- Indications
- Contraindications
- Risks/Complications
- Procedure
- Additional Points
- Section 5.1 Practical Respiratory System
- 5.1.1 Oxygen Administration in Intensive Care
- 5.1.2 Emergency Front of Neck Airway Management
- 5.1.3 Difficult Intubation Guidelines and Failed Airway Management
- 5.1.4 Principles of Performing Fibreoptic Bronchoscopy and Broncho-alveolar Lavage in the Intubated Patient
- 5.1.5 Percutaneous Tracheostomies and Management of Tracheostomy Emergencies
- 5.1.6 Chest Drain Insertion
- 5.1.7 Lung Ultrasound
- 5.1.8 Lung Function Testing
- Section 5.2 Practical Cardiovascular System
- Section 5.3 Practical Central Nervous System
- Section 5.4 Practical Gastrointestinal System
- Section 5.5 Practical Genitourinary System
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
5.1.4 - Principles of Performing Fibreoptic Bronchoscopy and Broncho-alveolar Lavage in the Intubated Patient
from Section 5.1 - Practical Respiratory System
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Introduction
- Classification of Devices
- Fixed-Performance Devices
- Variable Performance Devices
- Introduction: The 4th National Audit Project
- Anatomy
- Approaches
- Difficult Airway Society’s Recommended Technique
- Introduction: NAP4
- How to Predict an Anatomically Difficult Airway
- Equipment
- Difficult Airway Society Guidelines and Airway Management in Critically Ill Adults
- Tracheostomy difficulties
- Introduction
- Indications for Bronchoscopy in the ICU
- Contraindications
- Procedure
- Complications
- Conclusion
- Introduction
- Pre-procedural Considerations
- Procedure
- Post-procedure
- Acknowledgements
- Introduction
- Indications
- Contraindications (Relative)
- Technique for Insertion
- Drainage Bottles
- Pneumothorax Management
- Analysis of Fluid
- Complications
- Introduction
- Diagnosis of Acute Respiratory Failure
- Ultrasound in the Role of Weaning from Mechanical Ventilation
- Pleural Effusions
- Distinguishing Atelectasis from Pneumonia
- Ultrasound to Distinguish ARDS from Cardiac Pulmonary Oedema
- Introduction
- Spirometry
- Inspiratory and Expiratory Flow–Volume Loops in Upper Airway Obstruction
- Bronchodilator Response and Reversibility
- Lung Volumes
- Disease Patterns
- Gas Transfer
- Indications
- Contraindications to Line Insertion
- Risks/Complications
- Potential Insertion Sites
- Allen’s Test
- Procedure
- Introduction
- Localisation of Vasculature
- Techniques for Ultrasound-Guided Peripheral Vascular Access
- Introduction
- Indications
- Contraindications
- Complications
- Ultrasound
- Sites
- Procedure
- Confirmation of Line Placement
- Arterial Puncture
- Introduction
- Equipment Components
- Procedure
- Interpretation
- Clinical Use of Pulmonary Artery Catheters
- Complications
- Introduction
- Pad Positions
- Defibrillation
- Summary of Defibrillation Protocol in Advanced Life Support
- Optimising Defibrillation
- Oxygen
- Drugs in Defibrillation
- Energy Levels
- Implantable Cardioverter–Defibrillators
- Cardioversion outside the Cardiac Arrest Situation
- Complications
- Introduction
- Temporary
- Permanent Transvenous
- Miscellaneous
- Basic Pacing Concepts – Sensing and Capture
- Modes of Operation
- Management of Temporary Systems in the ICU
- Management of Permanent Systems in the ICU
- Pathophysiology of Cardiac Tamponade
- Aetiology of Pericardial Effusion
- Diagnosis
- Indications for Pericardiocentesis
- Contraindications of Pericardiocentesis
- Procedure
- Complications of Pericardiocentesis
- Introduction
- Pulmonary Artery Catheters
- Transoesophageal Echocardiography
- Doppler Devices
- Pulse Pressure Analysis
- Non-invasive Techniques
- Research Tools
- Introduction
- Lead placement and FICE views
- The Essence of FICE
- Common Pathologies Identified
- Acknowledgements
- Introduction
- Indications
- Contraindications
- Lumbar Punctures in the Emergency Setting
- Equipment and Technique
- Samples to Send
- Interpreting Results in Suspected Meningitis
- Complications
- Introduction
- Indications
- Anatomy, Physiology and Pharmacology
- Epidural Regimes
- Assessment and Monitoring
- Troubleshooting
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Volume Replacement
- Analysis of Fluid
- Complications
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Aftercare
- Complications
- Introduction
- Indications
- Contraindications
- Risks/Complications
- Procedure
- Additional Points
- Section 5.1 Practical Respiratory System
- 5.1.1 Oxygen Administration in Intensive Care
- 5.1.2 Emergency Front of Neck Airway Management
- 5.1.3 Difficult Intubation Guidelines and Failed Airway Management
- 5.1.4 Principles of Performing Fibreoptic Bronchoscopy and Broncho-alveolar Lavage in the Intubated Patient
- 5.1.5 Percutaneous Tracheostomies and Management of Tracheostomy Emergencies
- 5.1.6 Chest Drain Insertion
- 5.1.7 Lung Ultrasound
- 5.1.8 Lung Function Testing
- Section 5.2 Practical Cardiovascular System
- Section 5.3 Practical Central Nervous System
- Section 5.4 Practical Gastrointestinal System
- Section 5.5 Practical Genitourinary System
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. Fibreoptic bronchoscopy (FOB) is generally a safe procedure that is performed at the bedside in the ICU, thus avoiding potentially dangerous transfers out of the ICU.
2. FOB is utilised for both diagnostic and therapeutic purposes.
3. FOB-guided broncho-alveolar lavage (BAL) and protected brush specimen (PSB) are extremely valuable procedures and have a high diagnostic yield in identification of the causative organism in pneumonia.
4. FOB is increasingly used in managing difficult airway and in inserting percutaneous tracheostomy devices.
5. In intubated patients, FOB increases airway resistance during the procedure. This causes an increase in the peak inspiratory pressure (PIP) and peak end-expiratory pressure (PEEP), which may result in barotrauma.
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 534 - 537Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Bonella, F, Ohshimo, S, Bauer, P, Guzman, J, Costabel, U. Bronchoalveolar lavage. Eur Respir Mon 2010;48:59–72.Google Scholar
Bonnet, M, Monteiro, MB. Fiberoptic bronchoscopy in intensive care—particular aspects. Rev Port Med Int 2003;12:17–19.Google Scholar
Liebler, JM, Markin, CJ. Fiberoptic bronchoscopy for diagnosis and treatment. Crit Care Clin 2000;16:83–100.CrossRefGoogle ScholarPubMed
Marini, J, Pierson, D, Hudson, L. Acute lobar atelectasis: a prospective comparison of fiberoptic bronchoscopy and respiratory therapy. Am Rev Respir Dis 1979;119:971–8.Google ScholarPubMed
Raoof, S, Mehrishi, S, Prakash, UB. Role of bronchoscopy in modern medical intensive care unit. Clin Chest Med 2001;22:241–61.CrossRefGoogle ScholarPubMed
Tai, DYH. Bronchoscopy in the intensive care unit (ICU). Ann Acad Med Singapore 1998;27:552–9.Google ScholarPubMed