Fiberoptic bronchoscopy in a respiratory intensive care unit

• Published in: Medicina intensiva Vol. 36; no. 6; p. 389
• Main Authors: Lucena, C M, Martínez-Olondris, P, Badia, J R, Xaubet, A, Ferrer, M, Torres, A, Agustí, C
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.08.2012
• Subjects: Aged; Biopsy - methods; Bronchoalveolar Lavage Fluid; Bronchoscopes; Bronchoscopy - adverse effects; Bronchoscopy - utilization; Female; Fiber Optic Technology - instrumentation; Hospital Mortality; Humans; Immunocompromised Host; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Respiration, Artificial; Respiratory Care Units - methods; Respiratory Tract Diseases - diagnosis; Respiratory Tract Diseases - surgery; Sensitivity and Specificity; Tertiary Care Centers
• ISSN: 1578-6749
• DOI: 10.1016/j.medin.2011.11.004

To describe the indications, diagnostic performance and safety of fiberoptic bronchoscopy (FOB) performed in a respiratory intensive care unit (RICU). A prospective, observational study was carried out. A 6-bed RICU in a tertiary university hospital. Patients admitted to RICU who required FOB. None. FOB indications and complications, endoscopic procedures, time required to perform FOB. Sixty-nine out (23%) of the 297 patients admitted to the RICU underwent a total of 107 FOB. Sixty-eight percent of FOB were performed in patients on mechanical ventilation. FOB was performed for diagnostic and therapeutic purposes in 88 (82%) and 19 cases (18%), respectively. The study of pulmonary infiltrates was the main indication for diagnostic FOB (44 cases; 50%), particularly in immunocompromised patients (24 cases; 27%). In immunocompromised patients the diagnostic performance of FOB was significantly higher than in immunocompetent subjects (48% vs 30%; p<0.01). No major complications were recorded. Only a significant drop in PaO(2)/FiO(2) ratio was observed (182 ± 74 vs 163 ± 79; p<0.005) in patients undergoing bronchoalveolar lavage. Overall mortality in patients in the RICU was 14%. In patients requiring a single FOB procedure, mortality was 25%, versus 45% among those requiring more than one FOB procedure. These results show that FOB is used commonly in the RICU. It is a safe and fast procedure that contributes significantly to clinical management. Patients requiring additional FOB during admission to the RICU show high mortality.