Abstract
Bronchoscopy may be considered the “added value” in the diagnostic and therapeutic pathway of different clinical scenarios occurring in acute respiratory critically ill patients. Rigid bronchoscopy is mainly employed in emergent clinical situations due to central airways obstruction, haemoptysis, and inhaled foreign body. Flexible bronchoscopy (FBO) has larger fields of acute applications. In intensive care settings, FBO is useful to facilitate intubation in difficult airways, guide percutaneous dilatational tracheostomy, and mucous plugs causing lobar/lung atelectasis. FBO plays a central diagnostic role in acute respiratory failure caused by intra-thoracic tumors, interstitial lung diseases, and suspected severe pneumonia. “Bronchoscopic” sampling has to be considered when “non-invasive” techniques are not diagnostic in suspected ventilator-associated pneumonia and in non-ventilated immunosuppressed patients. The combined use of either noninvasive ventilation (NIV) or High-flow nasal cannula (HFNC) with bronchoscopy is useful in different scenarios; the largest body of proven successful evidence has been found for NIV-supported diagnostic FBO in non-ventilated high risk patients to prevent and avoid intubation. The expected diagnostic/therapeutic goals of acute bronchoscopy should be balanced against the potential severe risks (i.e., cardio-pulmonary complications, bleeding, and pneumothorax). Expertise of the team is fundamental to achieve the best rate of success with the lowest rate of complications of diagnostic and therapeutic bronchoscopic procedures in acute clinical circumstances.
Highlights
IntroductionPublisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
Other words, the likelihood of getting from acute bronchoscopy diagnostic findings that early broncho-alveolar lavage (BAL) and or protected-specimen brush (PSB) may be of clinical usefulness in immune-suppressed patients with may impact on changes of treatment and possibly on the outcome of patients admitted to lung infiltrates and/or pneumonia caused multi-resistant microorganisms
transbronchial lung biopsy (TBLB) is more likely to provide an additional diagnostic value of over BAL in selected categories of interstitial lung diseases (ILDs) patients presenting with acute respiratory failure (ARF), such as immune-suppressed conditions, granulomatous diseases and lymphangitis carcinomatosis; instead, the role of TBLB in acute patients with idiopathic ILDs is uncertain in terms of balance between benefits against risks [1,10,32,33,34,35]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Bronchoscopy was firstly introduced in 1897 for an emergent removal of an inhaled foreign body (FB). Bronchoscopy may be done with flexible and rigid instruments. Flexible bronchoscopy (FBO) is more widely employed due to its less invasiveness, deeper capability for exploration of bronchial tree, and quicker learning curve; its “ancillary techniques” allow sampling to be taken from lung and mediastinum, such as broncho-alveolar lavage (BAL), protected-specimen brush (PSB), trans-bronchial needle aspiration (TBNA), and transbronchial lung biopsy (TBLB) [1,2,4]. Rigid bronchoscopy (RB) has a more limited field of applications, but represents a mandatory safe and effective technique to perform interventional procedures, such as ablative treatments (laser, argon-plasma, electro-cautery, cryotherapy), airway’s stenting, as well as FBs removal [4].
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