Diagnostic
Collection of microbiological 9 cytological specimens (by
bronchoalveolar lavage, protected brush specimen, biopsy).
Cause of bronchial obstruction (e.g. clot, foreign body, neoplasm).
Extent of inhalation injury.
Diagnosis of ruptured trachea/bronchus.
Therapeutic
Clearance of secretions, inhaled vomitus, etc.
Removal of obstructing matter (e.g. mucus plug, blood clot, food,
tooth). Proximal obstruction rather than consolidation is suggested by
the X-ray appearance of a collapsed lung/lobe and no air bronchogram.
Cleansing/removing soot or other toxic materials, irrigation with saline.
Directed physiotherapy 9 saline to loosen secretions.
Directed placement of balloon catheter to arrest pulmonary bleeding.
To aid diffi cult endotracheal intubation.
Contraindications/cautions
Coagulopathy.
Severe hypoxaemia.
Procedure
It is diffi cult to perform bronchoscopy in a nasally intubated patient.
A narrow lumen scope can be used but suction is limited.
Pre-oxygenate with FIO2 1.0. Monitor with pulse oximetry.
Increase pressure alarm limit on ventilator.
Lubricate scope with lubricant gel/saline.
If unintubated, apply lidocaine gel to nares 9 spray to pharynx.
Consider short-term IV sedation 9 paralysis.
Insert scope nasally in a non-intubated patient or via the catheter
mount port if intubated. An assistant should support the ET tube
during the procedure to minimise trauma to trachea and/or scope.
Inject 2% lidocaine into trachea to prevent coughing and
haemodynamic effects from tracheal/carinal stimulation.
Perform thorough inspection and any necessary procedures. If SpO2
≤85% or haemodynamic disturbance occurs, remove scope and allow
re-oxygenation before continuing.
Bronchoalveolar lavage is performed by instillation of at least 60mL
of (preferably warm) isotonic saline into affected lung area without
suction, followed by aspiration into a sterile catheter trap. All
bronchoscopic samples should be sent promptly to the lab.
After procedure, reset ventilator as appropriate.
Complications
Hypoxaemia: from suction, loss of PEEP, partial obstruction of
endotracheal tube, and non-delivery of tidal volume.
Haemodynamic disturbance, including hypertension and tachycardia
(related to hypoxaemia, agitation, tracheal stimulation, etc.).
Bleeding.
Perforation (unusual though more common if biopsy taken).