Fiberoptic Bronchoscopy

on 31.1.08 with 0 comments



Explores the first 6 divisions of the tracheobronchial tree down to the subsegmental bronchi. Use a topical anesthetic only. Washings with isotonic saline can be sent to cytology or Microbiology .


Indications:
The indications for a bronchoscopy are many. The object in each setting is different.

Diagnostic:
For Endobronchial Symptoms or Signs

Symptoms and signs of endobronchial disease are the most common indications for a bronchoscopy.

  • Chronic cough
  • Hemoptysis
  • Atelectasis
  • Obstructive pneumonia
  • Localized wheezing

Lung Cancer:
Lung cancer is one of the most common conditions where a bronchoscopy is indicated. It is necessary for:
  • Tissue diagnosis
  • Staging
  • Early diagnosis
Burn:
Patients who sustained burns and suspected of having injuries to the respiratory passages are bronchoscoped.

Assessment of the Endotracheal Tube Position:

Therapeutic

Removal of Foreign Body:
In general, foreign body removal is best done with a rigid bronchoscopy under general anesthesia.

A fiberoptic bronchoscopy may be used as a screening procedure for suspected cases of aspiration. Patients with known or suspected foreign bodies should undergo a rigid bronchoscopy. If the evidence for aspiration is equivocal, patients should undergo a diagnostic flexible bronchoscopy, and then a rigid bronchoscopy if a foreign body is found.

There have been reports of foreign body extraction using flexible bronchoscopes, but this is poorly suited for such work.


Lung Abscess:
To Rule out Endobronchial Lesion and for Drainage

Tracheal Stenosis:
For Dilation

Refractory Atelectasis: With a Balloon Cuff

Respiratory Toilette:
Occasionally, a bronchoscopy will be indicated for respiratory toilette. As a general rule, postural drainage, tapotage, cough and suction of secretions are sufficient. If for some reason these cannot be done, then bronchoscopy can be done for respiratory toilette. Prospective studies have shown that a good intensive respiratory toilette can accomplish good results in the control of atelectasis.

However, there are many clinical circumstances when respiratory toilette cannot ideally be accomplished. They are as follows:
  • Spine injury
  • Balloon pump
  • Left lower lobe atelectasis
  • Weekends
  • Blind passage of the catheter to the left lower lobe is difficult. Hence, the poor success rate with respiratory toilette with lower lobe atelectasis.

Preliminary to Other Procedures

Pneumonia, Diffuse lung disease
A bronchoscopy is a preliminary to many other procedures . A bronchoscopy has to be done at times to obtain respiratory secretions for establishing the diagnosis of an infection. The choice of brushing, triple lumen Microbiology brush or broncho-alveolar lavage is made appropriate to the clinical situation. After inspection of the tracheobronchial tree, depending on the clinical situation, you can:
  • Brush
  • Biopsy
  • Transbronchial lung or mass biopsy
  • BAL
  • Triple lumen catheter
  • Lase

A bronchoscope acts as a medium through which these accessories are introduced to the desired location to accomplish the task.

Difficult Intubation:
If you experience difficulty in intubation, a fiberoptic bronchoscope can be used to help you. The endotracheal tube is passed over the bronchoscope and, under direct vision, can be introduced into the trachea.


Contraindications:
severe asthma, uncooperative pt, bleeding diathesis, uncorrectable hypoxemia/
hypercapnia.

Complications:
PTX, hemorrhage, bronchospasm, laryngospasm, epistaxis, vasovagal syncope and hypoxemia.

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Category: Medicine Notes

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