Fiberoptic bronchoscopy

Fiber-optic bronchoscopy in the intensive care unit is usually performed down an endotracheal tube of diameter 7 mm or more in ventilated patients. Patients should be preoxygenated, sedated, and paralysed. Non-intubated patients should have topical anesthetic applied to the upper respiratory tract; nebulized lidocaine (lignocaine) is particularly effective. They may be sedated if appropriate. The complication rate in non-intubated patients is less than 0.05 per cent, but this will be higher in ventilated patients where there is a risk of hemorrhage and deterioration in oxygenation. Bronchoscopic washings are often contaminated with multiple upper respiratory tract pathogens, and using a suction channel to introduce topical anesthetic increases this. Two main approaches have been adopted to reduce contamination of lower respiratory tract secretions obtained via the fiber-optic bronchoscope yet still retain the advantage of directed sampling.

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