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 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 >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. 1. Introduction Fiberoptic bronchoscopy (FOB) was first introduced in clinical practice in 1967 [1]. Since then, it is considered one of the most important techniques in pulmonary medicine. New advances emerge in the field over the years [2] and its potential is being recognized around the world as a contributor to the management of every pulmonary condition [3]. A wide range of indications exists for FOB in the intensive care unit (ICU) [4]. Most correspond to basic bronchoscopy with exploration, lavage, brushing, and forceps sampling as the primary used techniques [5–7]. It is recommended that intensive care units account for the facility to perform urgent and timely FOB for a range of therapeutic and diagnostic purposes [8]. Critical care settings demand that respiratory system problems be resolved and clinical decisions be made in a timely manner. Here we describe the impact in decision-making and problem solving of FOB in an ICU along with indications, complications and results of the procedure. 2. Materials and Methods 2.1. Study Design This is a prospective and descriptive cohort. 2.2. Setting The seven-bed respiratory intensive care unit (RICU) of the Department of Pneumology and Thoracic Surgery is one of the eight ICUs of the Hospital General de México O.D., a 901-bed teaching hospital. The RICU works as a closed unit with