Bronchoscopy in The Respiratory Intensive Care Unit: A 4-Year Review

Öz

Bronchoscopy is a valuable diagnostic and therapeutic procedure in intensive care units (ICUs), but real-world data regarding its application and safety in critically ill patients remain limited. This study aimed to evaluate the indications, findings, complications, and microbiological outcomes of bronchoscopy in an ICU setting. This retrospective study included 152 ICU patients who underwent 227 bronchoscopy procedures between July 2020 and November 2024. Demographic characteristics, procedural indications, oxygen support modalities, microbiological results, and complication rates were recorded. The median age of patients was 68 [IQR: 59–75] years, and 64.5% were male. Bronchoscopy was most frequently performed for the clearance of secretions and the treatment of atelectasis. Complete or partial resolution of atelectasis was achieved in 92.6% of such cases. Infectious pathogens were identified in 34.8% of all procedures. The most common complication was hypoxemia (12.8%), followed by arrhythmias (3.1%) and hemodynamic instability (1.8%). No serious adverse events were reported. No statistically significant difference in complication rates was observed between oxygen support groups. Bronchoscopy is a safe and effective tool for both diagnostic and therapeutic purposes in ICU patients when performed by experienced teams. Careful patient selection and appropriate oxygenation strategies are critical to minimise complications, especially hypoxemia.

Anahtar Kelimeler

• Bronchoscopy
• Intensive Care Unit
• Oxygen inhalation therapy

Solunum Yoğun Bakım Ünitesinde Bronkoskopi: 4 Yıllık Değerlendirme

Öz

Bronkoskopi, yoğun bakım ünitelerinde (YBÜ) değerli bir tanı ve tedavi prosedürüdür, ancak kritik hastalarda uygulanması ve güvenliği ile ilgili gerçek dünya verileri sınırlıdır. Bu çalışma, YBÜ ortamında bronkoskopinin endikasyonlarını, bulgularını, komplikasyonlarını ve mikrobiyolojik sonuçlarını değerlendirmek amacıyla yapılmıştır. Bu retrospektif çalışmaya, Temmuz 2020 ile Kasım 2024 arasında 227 bronkoskopi prosedürü uygulanan 152 YBÜ hastası dahil edildi. Demografik özellikler, prosedür endikasyonları, oksijen desteği yöntemleri, mikrobiyolojik sonuçlar ve komplikasyon oranları kaydedildi. Hastaların medyan yaşı 68 [IQR: 59–75] yıl idi ve %64,5'i erkekti. Bronkoskopi en sık sekresyonların temizlenmesi ve atelektazinin tedavisi için uygulandı. Bu vakaların %92,6'sında atelektazinin tamamen veya kısmen düzelmesi sağlandı. Tüm prosedürlerin %34,8'inde enfeksiyöz patojenler tespit edildi. En sık görülen komplikasyon hipoksemi (%12,8) idi, bunu aritmiler (%3,1) ve hemodinamik instabilite (%1,8) izledi. Ciddi advers olaylar bildirilmedi. Oksijen destek grupları arasında komplikasyon oranlarında istatistiksel olarak anlamlı bir fark gözlenmedi. Bronkoskopi, deneyimli ekipler tarafından uygulandığında yoğun bakım hastalarında hem tanı hem de tedavi amaçlı güvenli ve etkili bir araçtır. Komplikasyonları, özellikle hipoksemiyi en aza indirmek için dikkatli hasta seçimi ve uygun oksijenasyon stratejileri çok önemlidir.

Anahtar Kelimeler

• Bronkoskopi
• Yoğun Bakım Ünitesi
• Oksijen inhalasyon tedavisi

Kaynakça

1. 1. Scala R, Guidelli L. Clinical Value of Bronchoscopy in Acute Respiratory Failure. Diagnostics (Basel). 2021;11(10).
2. 2. Wayne MT, Valley TS, Arenberg DA, De Cardenas J, Prescott HC. Temporal Trends and Variation in Bronchoscopy Use for Acute Respiratory Failure in the United States. Chest. 2023;163(1):128-38.
3. 3. Menditto VG, Mei F, Fabrizzi B, Bonifazi M. Role of bronchoscopy in critically ill patients managed in intermediate care units - indications and complications: A narrative review. World J Crit Care Med. 2021;10(6):334-44.
4. 4. Ergan B, Nava S. The use of bronchoscopy in critically ill patients: considerations and complications. Expert Rev Respir Med. 2018;12(8):651-63.
5. 5. Goldstein RA, Rohatgi PK, Bergofsky EH, Block ER, Daniele RP, Dantzker DR, et al. Clinical role of bronchoalveolar lavage in adults with pulmonary disease. Am Rev Respir Dis. 1990;142(2):481-6.
6. 6. Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax. 2013;68 Suppl 1:i1-i44.
7. 7. Hogea SP, Tudorache E, Pescaru C, Marc M, Oancea C. Bronchoalveolar lavage: role in the evaluation of pulmonary interstitial disease. Expert Rev Respir Med. 2020;14(11):1117-30.
8. 8. Raoof S, Mehrishi S, Prakash UB. Role of bronchoscopy in modern medical intensive care unit. Clin Chest Med. 2001;22(2):241-61, vii.

9. 9. Martin-Loeches I, Artigas A, Gordo F, Añón JM, Rodríguez A, Blanch L, et al. [Current status of fibreoptic bronchoscopy in intensive care medicine]. Med Intensiva. 2012;36(9):644-9.
10. 10. Cuéllar-Mendoza D, Pérez-Nieto OR, Bautista-Aguilar GA, Trejo-Osornio DA, Zamorano-León CA, Deloya-Tomas E, et al. Clinical utilization of bronchoscopy in the ICU: indications, complications, and perspectives. Anesthesiology and Perioperative Science. 2025;3(3).
11. 11. Megahed MM, El-Menshawy AM, Ibrahim AM. Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis. Indian J Crit Care Med. 2021;25(2):146-52.
12. 12. Adolf J, Bartels H, Feussner H, Wittmann J. [Fiberoptic bronchoscopy in intensive care medicine--functional efficacy and methodological side effects]. Langenbecks Arch Chir. 1985;365(1):37-46.
13. 13. Turner JS, Willcox PA, Hayhurst MD, Potgieter PD. Fiberoptic bronchoscopy in the intensive care unit--a prospective study of 147 procedures in 107 patients. Crit Care Med. 1994;22(2):259-64.
14. 14. Álvarez-Maldonado P, Núñez-Pérez Redondo C, Casillas-Enríquez JD, Navarro-Reynoso F, Cicero-Sabido R. Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice? ISRN Endoscopy. 2013;2013:1-6.
15. 15. Trouillet JL, Guiguet M, Gibert C, Fagon JY, Dreyfuss D, Blanchet F, et al. Fiberoptic bronchoscopy in ventilated patients. Evaluation of cardiopulmonary risk under midazolam sedation. Chest. 1990;97(4):927-33.
16. 16. Harikrishnan S, Sundarajaperumal A, Nagarajan. Role of fiberoptic bronchoscopy in patients with respiratory complications in multispecialty intensive care units. IP Indian Journal of Immunology and Respiratory Medicine. 2020;3(3):117-20.
17. 17. Heyland DK, Cook DJ, Marshall J, Heule M, Guslits B, Lang J, et al. The clinical utility of invasive diagnostic techniques in the setting of ventilator-associated pneumonia. Canadian Critical Care Trials Group. Chest. 1999;115(4):1076-84.
18. 18. Solé Violán J, Fernández JA, Benítez AB, Cardeñosa Cendrero JA, Rodríguez de Castro F. Impact of quantitative invasive diagnostic techniques in the management and outcome of mechanically ventilated patients with suspected pneumonia. Crit Care Med. 2000;28(8):2737-41.
19. 19. Allam MGIM. Effect of Bronchoscopy on the Outcome of Patients with Severe Sepsis, AcuteRespiratory Distress Syndrome and Complicated by Ventilator AssociatedPneumonia from Prolonged Ventilation. The Open Anesthesia Journal. 2023;17(1).
20. 20. Zhang L, Li S, Yuan S, Lu X, Li J, Liu Y, et al. The Association Between Bronchoscopy and the Prognoses of Patients With Ventilator-Associated Pneumonia in Intensive Care Units: A Retrospective Study Based on the MIMIC-IV Database. Front Pharmacol. 2022;13:868920.
21. 21. Guidry CA, Mallicote MU, Petroze RT, Hranjec T, Rosenberger LH, Davies SW, et al. Influence of bronchoscopy on the diagnosis of and outcomes from ventilator-associated pneumonia. Surg Infect (Larchmt). 2014;15(5):527-32.
22. 22. Verma A, Sim WY, Tai DY, Goh SK, Kor AC, Phua CK, et al. Role of Bronchoscopy in Prompt Discharge From the Intensive Care Unit. J Bronchology Interv Pulmonol. 2016;23(2):123-30.
23. 23. Wahidi MM, Shojaee S, Lamb CR, Ost D, Maldonado F, Eapen G, et al. The Use of Bronchoscopy During the Coronavirus Disease 2019 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. Chest. 2020;158(3):1268-81.
24. 24. Longhini F, Bruni A, Saraco G, Garofalo E, Conti G. Should high-flow through nasal cannula be used during bronchoscopy in critically ill patients with hypoxemic acute respiratory failure? J Anesth Analg Crit Care. 2021;1(1):4.
25. 25. Pelaia C, Bruni A, Garofalo E, Rovida S, Arrighi E, Cammarota G, et al. Oxygenation strategies during flexible bronchoscopy: a review of the literature. Respir Res. 2021;22(1):253.
26. 26. Arias-Sanchez PP, Ledesma G, Cobos J, Tirape H, Jaramillo B, Ruiz J, et al. Changes in Oxygen Saturation During Fiberoptic Bronchoscopy: High-Flow Nasal Cannula versus Standard Oxygen Therapy. Respir Care. 2023;68(6):727-33.
27. 27. Simon M, Braune S, Frings D, Wiontzek AK, Klose H, Kluge S. High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy--a prospective randomised trial. Crit Care. 2014;18(6):712.