Bronchoscopy in the intensive care unit (ICU)

The diagnostic and therapeutic utility of flexible fibreoptic bronchoscopy (FFB), coupled with its minimal morbidity and mortality, have led to its increasing use in the care of the critically ill patients. FFB allows direct inspection of the upper and lower airway, and facilitates the diagnosis and management of a variety of pulmonary disorders. Patients in the intensive care unit are predisposed to a higher risk of complications as they are usually mechanically ventilated with positive end-expiratory pressure, and have other medical conditions such as coagulopathies, thrombocytopenia, uraemia, cardiac disease, hypoxaemia, pulmonary hypertension, and immunosuppression. An awareness of the higher risks associated with certain clinical conditions, and an understanding of the pathophysiological consequences associated with FFB should alert the bronchoscopists to take the necessary precautions to prevent and deal with these problems.