Role of fiberoptic bronchoscopy in patients with respiratory complications in multispecialty intensive care units

Abstract

Introduction: To determine the contribution and safety profile of flexible fiberoptic bronchoscopy in intensive care units in terms of therapeutic outcome in lung collapse patients. Methodology: Patients with respiratory complications from various speciality intensive care units were enrolled. After clinical and radiological evaluation, if conservative management fails, bronchoscopic intervention was considered. Bronchoscopy was performed according to British Thoracic Society guidelines after informed consent. Swivel-T-Tube adapter was used for the patients in mechanical ventilation. Data such as chest radiograph, arterial blood gas, Bacterial culture of tracheal and BAL secretions between before and after brochcoscopy (6 & 24 hrs) were analysed using standard SPSS software. Results: In our study 63 patients were enrolled, Most of the patients were in mechanical ventilation 85% (n=54/63). In our study, the indications for bronchoscopy were suspected atelectasis 57.1% (n=36), persistent pulmonary infiltrates 30% (n=27). In suspected atelectasis cases(n=36) bronchoscopic findings were mucous plug in 61%(n=22), blood clot in 11%(n=4) and purulent secretions 22% (n=8) and mucoid secretions in 5% ( n=2). Post brochoscopic chest radiograph of suspected ateletasis showed partial resolution in 38.8% (n=14) and complete resolution in 47.2% (n=17). Conclusion: In our study contribution of bronchoscopy played a vital role in therapeutic outcome. Patients had good response to bronchoscopy 85% improvement when intervened within 5 days of admission in ICU. No life threatening complications were encountered; hence bronchoscopy is safe in critically ill patients, if basic precautions are taken. Keywords: BAL and VAP; Fiberoptic bronchoscopy in intensive care units; Lung atelectasis in ICU; Safety of FOB in ICU.