Bronchoscopy is frequently performed both as a diagnostic and
therapeutic maneuver in the intensive care unit (ICU), wherein a
flexible endoscope is threaded into the airways. The bronchoscope has
a fiberoptic light source and suction channels as well as cables
allowing the tip of the device to be flexed and retroflexed in one
plane (Figure 30-1).
- ▪ Fiberoptic bronchoscope (FOB): Commonly used in the
- ▪ Rigid bronchoscope: Inflexible variant bronchoscope not
typically used in the ICU.
- ▪ Fiberoptic intubation: Endotracheal intubation in which
the bronchoscope is advanced through the nose or mouth and into
the proximal trachea, after which an endotracheal tube is threaded
over it into the airway.
- ▪ Diagnostic bronchoscopy: May be performed to evaluate the
character of the airways (ie, for edema, bleeding source), to obtain
selected pathological specimens (ie, cultures, or tissue).
- ▪ Therapeutic bronchoscopy: May be performed to remove secretions,
clots, or foreign bodies from the airways.
- ▪ Prior to performance of bronchoscopy, consent and
the universal protocol should be performed as in Section I.
- ▪ The operator should determine the approach to bronchoscopy.
- —Awake-sedated bronchoscopy: This approach
may be selected for patients in whom there is no need for an endotracheal
tube and involves topical anesthesia of the proximal airway as well
- —Endotracheal: This approach is more common in patients
in the ICU in whom bronchoscopy is performed through an existing
artificial airway (ie, endotracheal tube or tracheostomy) as in
- ▪ The operator should be familiar with proximal airway
anatomy (Figure 30-3).
- ▪ The bronchoscope can be advanced and withdrawn and the
tip can be flexed with a thumb control to navigate the airways (Figure
30-4)—the index finger is used to control suction.
- ▪ Airway bifurcations should be identified and may be off-axis
depending on the operator’s location relative to the patient
and the rotation of the tip of the bronchoscope relative to the
hand control (Figures 30-5 and 30-6).
- ▪ Secretions (Figure 30-7), blood, pus, or foreign bodies
may be identified in the airway and should be removed to prevent
- ▪ Suctioned material can be captured from the suction line
and sent for culture or pathologic identification (Figure 30-8).
Bronchoscopy through an endotracheal tube in an intubated
The hand controls of a flexible bronchoscope.