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5.1.4 - Principles of Performing Fibreoptic Bronchoscopy and Broncho-alveolar Lavage in the Intubated Patient
from Section 5.1 - Practical Respiratory System
- By Nicola Rowe, Ramprasad Matsa
Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
Book:

Intensive Care Medicine

Published online:

27 July 2023

Print publication:

01 December 2021, pp 534-537
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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.