Safety Of Fiberoptic Bronchoscopy Research Articles

ЛЕГЕНЕВИЙ АЛЬВЕОЛЯРНИЙ ПРОТЕЇНОЗ: ВИПАДОК СУБТОТАЛЬНОГО УРАЖЕННЯ ПАРЕНХІМИ ЛЕГЕНЬ)

Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease, characterized by the intraalveolar accumulation of surfactant-like lipoprotein substance. There are three forms of the disease: autoimmune (formerly known as idiopathic), secondary and congenital PAP. The disturbances of surfactant metabolism (protein-lipoid complex secreted by type II pneumocytes) play the crucial role in the development of the disease. Surfactant decreases a surface tension of alveoli and prevents its collapse at the end of the expiration and takes part in protection against infections as well. Surfactant is inactivated through the transformation into the surface-inactive aggregates, which are mainly absorbed by type II pneumocytes. The rest of surfactant are catabolized by alveolar macrophages (AM). This process is regulated by cytokines, especially granulocyte-macrophage colony-stimulating factor (GM-CSF) being the most important of them. Disturbances of interrelation between GM-CSF and cellular receptors blocks the signals to effector cells for surfactant deactivation. This is resulted in excessive accumulation of surfactant in alveoli. General lavage of the lung is a standard method of symptomatic management of PAP. Contemporary pathogenesis treatment uses two approaches — increasing the clearance of surfactant by means of exogenous GM-CSF administration and decreasing the level of GM-CSF antibodies using the rituximab and plasmapheresis. Due to the use of broncho-alveolar lavage (BAL) 5-year survival rate of th patients reaches 95 %. The mortality depends on the area of lung lesion and reversely correlated with the timely diagnosis and treatment. We report the case of subtotal lung parenchyma lesion associated with severe respiratory failure in 46 years old patient. Three series of BAL (5 procedures in each with 1-2 months interval) were performed using the limited volume of lavage fluid due to the severity of the patient’s condition. The results was an improvement of clinical condition, resolution of respiratory failure, significant reduction of the size of the lesions, improved lung transparency on CT scan, restoration of lung diffusion and total lung capacity. Conclusion. Therapeutic BAL is an effective method of PAP management. The outcome of clinical case presented and our many years experience confirm not only the effectiveness of conventional BAL with reduced lavage volume application but also a safety of fiberoptic bronchoscopy, especially in patients with subtotal involvement of lung parenchyma. Key words: pulmonary alveolar proteinosis, subtotal pulmonary parenchyma involvement, pulmonary bronchoalveolar lavage, efficiency.

Safety of Fiberoptic Bronchoscopy in Airway Pressure Release Ventilation Mode in Critically Ill Patients: Are These Results Safe?

Safety of Fiberoptic Bronchoscopy in Airway Pressure Release Ventilation Mode in Critically Ill Patients: Are These Results Safe?

Utility and Safety of Fiberoptic Bronchoscopy in Patients Infected with COVID-19. A Case Series

Bronchoscopy is a safe diagnostic and therapeutic tool. Performance of bronchoscopy in patients with highly communicable lung diseases like SARS-CoV-2 infection is controversial due to the risk for healthcare personnel.

Fiberoptic Bronchoscopy as a Diagnostic Tool in Neonatal Intensive Care Unit: A Single Center Experience

Background: Respiratory disorders are recognized as a leading cause of morbidity and mortality in neonates. Fiberoptic Bronchoscopy (FOB) is used by pediatricians both for diagnostic and therapeutic indications in children. Nonetheless, there is a paucity of data regarding the diagnostic utility and safety of FOB in neonates, and it has remained relatively under-used in the care of neonates. The present study provided a practical overview of the wide diagnostic aspects of the FOB in newborns hospitalized in the Neonatal Intensive Care Unit (NICU). Frequencies of common indications, their findings, and highlights contribute to the quick management of neonates with respiratory disorders. Methods: This descriptive study was conducted in the NICU of Namazi hospital and included 150 neonates with various respiratory problems admitted over 5 years within 2013-2018. All subjects underwent FOB and bronchoalveolar Lavage (BAL) using a bronchoscope of 2.8 (EVIS EXERA III Olympus bronchoscope). Results: The greatest indications for performing FOB entailed hypersecretion in 138 (92%) cases, prolonged mechanical ventilation in 108 (72%) neonates, and persistent radiological finding in 97 (64.6%) subjects. Bronchoscopy detected various airways anomalies, such as Laryngomalacia (72%), Tracheobronchomalacia (64%), subglottic stenosis (26%), vocal cord paresis (18%), tracheoesophageal fistula (6.7%), laryngeal cleft (6%), and laryngeal web (4%). BAL results demonstrated that the cultures were positive in 20 (13.33%) neonates. Acinetobacter was the most commonly reported bacterial infection observed in 8% of neonates. Conclusion: As evidenced by the obtained results, when performed by an experienced and well-trained person and in an environment with appropriate facilities, FOB can be a safe and efficient tool for the early diagnosis of numerous airway disorders among neonates admitted to NICUs.

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

To evaluate the indications and the safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL), protected specimen brushing (PSB), endobronchial biopsy (EBB), and transbronchial biopsy (TBB) in a population of very elderly patients. We performed a retrospective study of all adult patients, aged 50 years or older, who underwent FOB in the Bronchology Unit of the University of Parma Hospital between 1 January, 2003 and 31 April, 2005. Bronchoscopy records of 436 consecutive patients, including 191 patients, 75 yrs of age and older ("very elderly"; = > 75 yrs), were reviewed. Patients aged < 75 years and aged =/> 75 years were no different with regard to gender, BMI, baseline FEV1/FVC ratio, baseline SaO2, and blood pressure. The primary indication in patients aged < 75 years, was to assist in the diagnosis of a pulmonary mass of unknown aetiology (33%) and to remove secretions in the very elderly patients (31%). Indications for FOB and sampling procedures in the two groups were similar. Approximately 30% of patients in each group required supplemental oxygen during the procedure and fever occurred in 9.2% and 10.3% of patients, respectively. Hypertension and bleeding were relatively rare and did not occur more often in the very elderly. Indication for FOB did not vary with age and adverse events in both groups were uncommon and generally not severe.

Analysis on utility and efficacy of fiberoptic bronchoscopy in intensive care unit

To evaluate the utility and safety of fiberoptic bronchoscopy (FOB) in an intensive care unit (ICU). From Aug 2013 to Aug 2014, out of 492 patients admitted into Beijing Haidian Hospital ICU, 86 patients were included according to the study. Data including age, sex, APACHE, SAPS and Disease type, were processed using SPSS16.0. A total of 104 FOBs were performed in 86 patients P who were admitted to the ICU. FOB was useful in 64% of diagnostic procedures and 81% of therapeutic procedures, with an overall utility of 72%. The utility according to pneumonia in 32 cases, utility of 51%; percutaneous tracheostomy guidance in 26 cases, utility of 100%; atelectasis in 20 cases, utility of 75%; airway exploration in 18 cases, utility of 75%; hemoptysis in 3 cases, utility of 100%; and difficult airway intubation in 5 cases, utility of 100%. A decrease in pulse-oximeter oxygen saturation (SpO2) of >5% during FOB was present in 65% cases. Mean SpO2 before FOB was 94.0%±5.2%. During the procedure, the mean lowest SpO2 was 86.8%±8.4% (P<0.000 1) and the mean postprocedural SpO2 was 93.0%±4.5% (P=0.82). The other minor complications were present in 3.9% of cases. FOB has a great application field for the patients in ICU. The utility and safety of this operation is credible.

Application and safety of bedside flexible fiberoptic bronchoscopy in PICU

Objective To discuss the role and safety of fiberoptic bronchoscopy for diagnosing and treating respiratory disease in PICU. Methods A total of 95 eligible children with respiratory diseases admi-tted in PICU of Hu′nan Province Children′s Hospital were enrolled in this retrospective study from January 2013 to December 2013, and the efficacy and complications of fiberoptic bronchoscopy were assessed. Results A total of 95 children underwented bronchoscopy 112 times, the most common of microscopic examination results was tracheal bronchitis (62.1%), followed by congenital airway abnormality (21.1%); 58 times (56.9%) showed becteria positive in 102 times lavage and sputum culture results, including 16 times (27.6%) of Klebsiella pneumoniae bacteria, 12 times (20.7%) of Acinetobacter baumannii. After underwenting bronchoscopy and lavage wash, blood gas analysis of pH value, PaO2, PaCO2, SaO2 had significant improvement than before (P 0.05). The intraoperative and postoperative transient complications were observed in 38 times (33.9%). Conclusion The application of fiberoptic bronchoscopy for diagnosing and treating disease in PICU has a certain value, its overall safety is reliable. Key words: Fiber bronchoscope; Pediatric intensive care unit; Safety

Role of bronchoscopy during non invasive ventilation in hypercapnic respiratory failure

IntroductionNon invasive positive pressure ventilation (NIPPV) is the first line treatment for hypercapnic acute respiratory failure (ARF) secondary to COPD exacerbation in selected patients. Limited data exist supporting the use of fiberoptic bronchoscopy (FOB) during this clinical setting. The aim of this study is to assess the role of FOB during NIPPV in patients with decompensated COPD acute exacerbation. MethodsThis study is a randomized prospective case control pilot study carried out on 50 patients - admitted to critical care units at Alexandria University Hospital, Egypt - suffering from hypercapnic ARF secondary to COPD exacerbation with Kelly Matthay Score from 2 to 4. All patients received NIPPV. Patients were divided randomly into 2 equal groups: group I (cases) (25 patients) was subjected to additional intervention of early FOB during the first 6–12h from admission while group II (control) (25 patients) received the conventional treatment and NIPPV only. Outcome parameters measured were changes in ABG data, duration of NIPPV, rate of its success, ICU stay and mortality as well as the safety of FOB and possible complications. ResultsNo significant difference was detected between the 2 groups regarding the baseline characteristics. No serious complications happened from FOB, and Oxygen desaturation happened in 4/25 patients (16%), Tachycardia in 2/25 patients (8%). In group I, 23 patients (92%) were successfully weaned from NIPPV versus 16 patients (64%) in group II (p=0.037). Total duration of NIPPV was 28.52h in group I versus 56.25h in group II (p=0.001). Length of ICU stay was 4.84days in group I versus 8.68days in group II (p=0.001). Only 1 patient died in group I versus 3 patients in group II (p=0.609). ConclusionThe early application of FOB during NIPPV in patients with ARF due to COPD exacerbation was shown to be safe. Significant improvement in the outcome of patients who underwent FOB was noticed in terms of improved ABG data, shorter duration of NIPPV, higher percentage of success and shorter ICU stay while no significant difference was detected in mortality.

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

Purpose. We describe characteristics, utility, and safety of fiberoptic bronchoscopy (FOB) in an intensive care unit (ICU). Methods. Prospective and descriptive cohort of patients admitted to a respiratory ICU from March 2010 to June 2012. Results. A total of 102 FOBs were performed in 84 patients among 580 patients that were admitted to the ICU. Mean age was 48±17 years. FOB was useful in 65% of diagnostic procedures and 83% of therapeutic procedures, with an overall utility of 75%. Indications and utility according to indication were pneumonia in 31 cases, utility of 52%; percutaneous tracheostomy guidance in 26 cases, utility of 100%; atelectasis in 25 cases, utility of 76%; airway exploration in 16 cases, utility of 75%; hemoptysis in two cases, utility of 100%; and difficult airway intubation in two cases, utility of 100%. A decrease in oxygen saturation (SpO2) of &gt;5% during FOB was present in 65% of cases, and other minor complications were present in 3.9% of cases. Conclusions. Reasons for performing FOB in the ICU have remained relatively stable over time with the exception of the addition of percutaneous tracheostomy guidance. Our series documents current indications and also the utility and safety of this procedure.

Safety of performing fiberoptic bronchoscopy in critically ill hypoxemic patients with acute respiratory failure.

The safety of fiberoptic bronchoscopy (FOB) in nonintubated critically ill patients with acute respiratory failure has not been extensively evaluated. We aimed to measure the incidence of intubation and the need to increase ventilatory support following FOB and to identify predictive factors for this event. A prospective multicenter observational study was carried out in eight French adult intensive care units. The study included 169 FOB performed in patients with a PaO(2)/FiO(2) ratio ≤ 300. The main end-point was intubation rate. The secondary end-point was rate of increased ventilatory support defined as an increase in oxygen requirement >50 %, the need to start noninvasive positive pressure ventilation (NI-PPV) or increase NI-PPV support. Within 24 h, an increase in ventilatory support was required following 59 bronchoscopies (35 %), of which 25 (15 %) led to endotracheal intubation. The existence of chronic obstructive pulmonary disease (COPD; OR 5.2, 95 % CI 1.6-17.8; p = 0.007) or immunosuppression (OR 5.4, 95 % CI 1.7-17.2; p = 0.004] were significantly associated with the need for intubation in the multivariable analysis. None of the baseline physiological parameters including the PaO(2)/FiO(2) ratio was associated with intubation. Bronchoscopy is often followed by an increase in ventilatory support in hypoxemic critically ill patients, but less frequently by the need for intubation. COPD and immunosuppression are associated with the need for invasive ventilation in the 24 h following bronchoscopy.

Fiberoptic bronchoscopy in a respiratory intensive care unit

ObjectiveTo describe the indications, diagnostic performance and safety of fiberoptic bronchoscopy (FOB) performed in a respiratory intensive care unit (RICU). DesignA prospective, observational study was carried out. SettingA 6-bed RICU in a tertiary university hospital. PatientsPatients admitted to RICU who required FOB. InterventionsNone. Main measurementsFOB indications and complications, endoscopic procedures, time required to perform FOB. ResultsSixty-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 PaO2/FiO2 ratio was observed (182±74 vs 163±79; p<0.005) in patients undergoing bronchoalveolar lavage (BAL). Overall mortality in patients in the RICU was 14%. In patients requiring a single FOB procedure, mortality was 25% vs 45% among those requiring more than one FOB procedure. ConclusionsThese 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.

Fibrobroncoscopia en una unidad de vigilancia intensiva respiratoria

ObjectiveTo describe the indications, diagnostic performance and safety of fiberoptic bronchoscopy (FOB) performed in a respiratory intensive care unit (RICU). DesignA prospective, observational study was carried out. SettingA 6-bed RICU in a tertiary university hospital. PatientsPatients admitted to RICU who required FOB. InterventionsNone. Main measurementsFOB indications and complications, endoscopic procedures, time required to perform FOB. ResultsSixty-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 PaO2/FiO2 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. ConclusionsThese 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.

The feasibility and safety of fiberoptic bronchoscopy during noninvasive ventilation in patients with established acute lung injury: another small brick in the wall

In hypoxemic patients needing fiberoptic bronchoscopy (FOB), noninvasive ventilation (NIV) has been used to prevent gas-exchange deterioration associated with FOB and to compensate for the increase in work of breathing occurring during FOB, thus avoiding endotracheal intubation and its related complications. The application of NIV to allow FOB has been found of particular interest in the diagnosis of pneumonia in patients spontaneously breathing and in those who started NIV to assist FOB. There is less information for patients who were already receiving NIV for acute respiratory failure and who were scheduled to undergo FOB. In the previous issue of Critical Care, the study by Baumann and colleagues adds new information to this specific issue, addressing the feasibility and safety of FOB during NIV in patients with established hypoxemic respiratory failure.

Fiberoptic Bronchoscopy in Neonatal and Pediatric Intensive Care Units: A 5-Year Experience

Objectives: To determine the value and safety of fiberoptic bronchoscopy in neonatal and pediatric intensive care units (NICUs, PICUs). Subject and Methods: A total of 53 fiberoptic bronchoscopy procedures on 47 patients were reviewed. Bronchoalveolar lavage (BAL) was performed in 23 patients. Results: The primary diseases were pneumonia (n = 16), foreign body aspiration (n = 14), congenital airway abnormality (n = 12), trauma and/or following operations (n = 4) and Guillain-Barré syndrome (n = 1). The major bronchoscopic findings included inflammation in 26 patients, foreign body in 14, congenital airway abnormality in 12 and blood clotting in 3. Microbiology on BAL fluid was positive in 19 of 23 patients. In 23 patients with atelectasis, full and partial re-expansion was obtained in 14 and 6 patients, respectively, at 24 h after the procedures. The clinical features of 9 patients with sputum retention or blood clotting improved significantly after BAL. Positive or negative microbiologic BAL fluid results changed treatment in 11 patients, leading to marked clinical improvement in 9 patients. Moreover, 13 patients were extubated within 24 h of bronchoscopy. Conclusion: These data show that fiberoptic bronchoscopy is safe and effective in the diagnosis and therapy of pulmonary disorders in NICUs and PICUs.

Safety of fiberoptic bronchoscopy in neonate respiratory diseases

目的 评价纤维支气管镜(简称纤支镜)在新生儿呼吸系统疾病临床应用的安全性.方法 对12例纤支镜检查新生儿进行前瞻性研究,分析新生儿呼吸系统疾病特征,观察纤支镜检查前后生命体征的变化,评价气管内压力支持通气的作用.结果 12例新生儿顺利完成纤支镜检查,其中NICU患儿10例(83%).11例发生并发症,发生率为92%,全部为明显低氧血症及高碳酸血症,其中合并X线胸片肺部阴影扩大3例(25%),呼吸道出血2例(17%),心力衰竭1例(8%).检查前后脉搏、血压差异无显著性(P＞0.05),而检查后气促症状改善(P＜0.05).心力衰竭应用西地兰、速尿治疗后纠正,呼吸道出血、肺部阴影扩大无需处理.气管内压力支持通气可保证新生儿纤支镜检查期间正常氧合.结论 纤支镜检查在新生儿呼吸系统疾病(包括部分重症新生儿)的临床应用是安全的。

Fiberoptic bronchoscopy during noninvasive positive pressure ventilation delivered by helmet.

Abstract Objective. To evaluate the feasibility and safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) during noninvasive positive pressure ventilation (NPPV) delivered by helmet in patients with acute respiratory failure (ARF) and suspected pneumonia. Design and setting. Prospective, clinical investigation in a general intensive care unit (ICU) of a university hospital. Patients and participants. Four adult patients with ARF who underwent NPPV via the helmet and required fiberoptic BAL for suspected pneumonia. Interventions. NPPV was delivered through the helmet in the pressure support ventilation mode. The specific seal connector placed in the plastic ring of the helmet allowed the passage of the bronchoscope, maintaining assisted ventilation. Arterial blood gas levels, pH, oxygen saturation, respiratory rate, heart rate, and mean arterial blood pressure were monitored during the study. Results. Helmet NPPV avoided gas exchanges deterioration during FOB and BAL, with good tolerance. During the procedure heart rate increased by 5% and mean arterial blood pressure by 7% over baseline; these levels returned to prebronchoscopic values immediately after the withdrawal of the bronchoscope. Endotracheal intubation was never required during the 24 h after the procedure. BAL yielded diagnostic information in three of four patients. Conclusions. NPPV through the helmet allows a safe diagnostic FOB with BAL in patients with hypoxemic ARF, avoiding gas exchange deterioration, and endotracheal intubation. Electronic supplementary material is available if you access this article at http://dx.doi.org/10.1007/s00134-002-1554-5. On that page (frame on the left side), a link takes you directly to the supplementary materials.

Fiberoptic bronchoscopy during noninvasive positive pressure ventilation delivered by helmet.

To evaluate the feasibility and safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) during noninvasive positive pressure ventilation (NPPV) delivered by helmet in patients with acute respiratory failure (ARF) and suspected pneumonia. Prospective, clinical investigation in a general intensive care unit (ICU) of a university hospital. Four adult patients with ARF who underwent NPPV via the helmet and required fiberoptic BAL for suspected pneumonia. NPPV was delivered through the helmet in the pressure support ventilation mode. The specific seal connector placed in the plastic ring of the helmet allowed the passage of the bronchoscope, maintaining assisted ventilation. Arterial blood gas levels, pH, oxygen saturation, respiratory rate, heart rate, and mean arterial blood pressure were monitored during the study. Helmet NPPV avoided gas exchanges deterioration during FOB and BAL, with good tolerance. During the procedure heart rate increased by 5% and mean arterial blood pressure by 7% over baseline; these levels returned to prebronchoscopic values immediately after the withdrawal of the bronchoscope. Endotracheal intubation was never required during the 24 h after the procedure. BAL yielded diagnostic information in three of four patients. NPPV through the helmet allows a safe diagnostic FOB with BAL in patients with hypoxemic ARF, avoiding gas exchange deterioration, and endotracheal intubation. is available if you access this article at http://dx.doi.org/10.1007/s00134-002-1554-5. On that page (frame on the left side), a link takes you directly to the supplementary materials.

The Safety of Fiberoptic Bronchoscopy in Asthma Cases

The Safety of Fiberoptic Bronchoscopy in Asthma Cases

Fiberoptic Bronchoscopy and Intracranial Pressure-To the Editor

The letter by Tai-Shion Lee, M.D., regarding our article “Fiberoptic Bronchoscopy in the Presence of Space Occupying Intracranial Lesions” (Chest 1993; 104:101-03) raises concerns regarding the safety of fiberoptic bronchoscopy in patients with central nervous system (CNS) trauma, and raised intracranial pressure (ICP) that has been documented by invasive monitoring. His observations and suggestions regarding that special setting deserve careful consideration. None of the patients in our series fell into that diagnostic category.

Fiberoptic bronchoscopy in the intensive care unit--a prospective study of 147 procedures in 107 patients.

To determine the value and safety of fiberoptic bronchoscopy in an intensive care unit (ICU). Prospective survey. ICUs at a tertiary care hospital (except for seven procedures that were performed at a peripheral hospital ICU). A total of 107 patients with a mean age of 43.9 yrs (range 15 to 84). One hundred forty-seven fiberoptic bronchoscopy procedures (116 performed on patients who were undergoing mechanical ventilation) were performed on 107 patients. Ninety-four procedures were for diagnostic reasons (upper and lower airway inspection, focal and diffuse pulmonary infiltrates), 37 for therapeutic reasons (bronchial toilet, pulmonary hemorrhage, endotracheal intubation), and 16 for both reasons. Topical anaesthesia was used for fiberoptic bronchoscopy; sedation was rarely needed. Appropriate diagnostic and therapeutic procedures were performed. Oxygen saturation, electrocardiogram, and blood pressure were monitored. Transbronchial biopsies (all on mechanical ventilation) for diffuse pulmonary infiltrates were diagnostic in five of seven cases, and were suggestive of the diagnosis in a further case. Endobronchial biopsies were not diagnostic in any of three cases. Bronchial brushings for microbiology were positive in nine of 50 procedures and for cytology in one of nine procedures. Protected specimen brushes for pulmonary infiltrates gave positive microbiology findings in five of 23 procedures. In pulmonary hemorrhage, focal bleeding was found in five cases, diffuse bleeding in four, and no bleeding source in three. In lobar atelectasis, bronchial toilet led to full reexpansion (n = 20 procedures), partial reexpansion (n = 5), and no change (n = 3). Intubation with fiberoptic bronchoscopy was successful in four of five patients. Hypoxemia (oxygen saturation < 90%) occurred in 29 procedures; it caused no problems. Complications included hemorrhage (n = 2), supraventricular tachycardia (n = 1), pneumothorax (n = 1), pneumatocele (n = 1), and bronchospasm (n = 1). No deaths were attributable to fiberoptic bronchoscopy. Fiberoptic bronchoscopy in the ICU is safe, contributes valuable diagnostic information, and is useful for therapeutic purposes.