Fibreoptic Bronchoscopy-its Role in Pulmonary Medicine-Current Trends in Intensive Care Unit

Abstract

Fibreoptic Bronchoscopy is an endoscopic procedure to visualize the tracheobronchial tree and also to obtain bronchial washings, biopsies, brush smears, transbronchial biopsies to arrive at an etiological diagnosis of the underlying disease process responsible for the nonresolving shadows in the lung, these can facilitate therapeutic decision. Utilization of bronchoscopy in the intensive care unit (ICU) has made the diagnosis and treatment of many diseases presenting as acute respiratory illness, more possible to interventional pulmonologists and intensivists although challenging in the critical ill cases, specially in ventilator support. We report our one year experience with the use of flexible fiberoptic bronchoscopy. A total 205 cases were undergone this procedure during Aug 2022 till July 2023 out of which 169 cases were taken up from the wards and rest 36 cases were taken up from the intensive care units. Pre-bronchoscopy screening was done. Of 205 patients, there were 124 Male patients and 81 Female patients. Mean age of the patients was 50.1 years. Among 169 cases in the ward were mainly non-resolving consolidation in 99 (58%) cases followed by pulmonary mass lesion in 31(18.3%) cases, Cavitary lesion in 22 (13%) cases, collapse with bronchiectasis-18(10.6%) and in 16 cases with hemoptysis with Normal X-ray. The diagnostic yield were Pulmonary infection - Non TB- 46 %, Tuberculosis-8%, Malignancy 17% – Squamous cell carcinoma-2 cases (18%), Adenocarcinoma 4 cases, Small Cell carcinoma -5 cases Bronchoscopy has ultimately lead to change in therapy in 70% cases, Bronchoscopy among 36 (17.5%)cases in ICU were mainly related to non-resolving consolidation 12(33%), hemoptysis 8(22.4%), for tracheal intubation-3(8.3%). Therapeutic bronchoscopy was performed in collapse due to retained secretion in 13(36%) cases. Complications were minimal indicating its safety in expert hands.