الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Summary
Bronchoscopy is a fundamental technique used
in the study of respi ratory diseases. I t provides
visual izat ion of the upper ai rway and ini t ial
divisions of the tracheobronchial tree and allows for
samples to be taken f rom the t rachea, bronchi ,
medias t inum and lung parenchyma. Fur thermore, i t is
essent ial in the therapeut ic management of pat ients
wi th hemoptysis , aspi rat ion of a foreign body, excess
secret ions , neoplast ic lesions and obst ruct ion of the
cent ral ai rway.
Respi ratory involvement is common in the
cr i t ical ly i l l pat ient in the intensive care uni t ( ICU)
wi th 30-50% of the admissions requi r ing the use of
mechanical vent i lat ion. FFB remains a very valuable
tool in the evaluat ion and management of these
pat ients as wel l as to evaluate compl icat ions of
mechanical vent i lat ion especial ly atelectasis and
VAP. Bronchoscopy in the ICU plays a role as a
diagnost ic and therapeut ic tool .
Bronchoscopy can establ ish the diagnosis in
many of the infect ions as wel l as in non - infect ious
et iologies l ike acute eosinophi l ic pneumonia, di f fuse
alveolar hemor rhage or damage, pulmonary alveolar
Uses of flexible fiberoptic bronchoscopy in ICU
(92)
proteinosis , l ipoid pneumonia, eosinophi l ic
granulomas , and rarely rapidly progressing
neoplasms . The use of TBBx can add addi t ional
diagnosis in selected pat ients .
Fiberopt ic intubat ion is a key aspect in the
management of di f f icul t intubat ions and forms par t
of several di f f icul t ai rway algor i thms . Intubat ion in
these instances is performed using the bronchoscope as
an obturator. Care must be taken to use a bite guard or
an oral ai rway as damage to the scope by pat ient
bi te.
In order to per form a FFB, a wel l -equipped
faci l i ty, t rained personnel , pre -procedure evaluat ion,
and moni tor ing is highly recommended s should be
avoided. Standard moni tor ing i s mandatory whi le
using ei ther moni tored anesthesia care sedat ion or
general anes thesia. Moni tor ing the depth of
anesthesia might faci l i tate appropr iate t i t rat ion of
the int ravenous drugs and avoid delayed emergence.
Additional ly, resuscitation equipment for airway
emergencies (nasal and oral ai rways , anesthesia
masks , laryngoscope, endot racheal tubes , intubat ing
stylets , sel f - inf lat ing bag-valve-mask and suct ion)
Uses of flexible fiberoptic bronchoscopy in ICU
(93)
and cardiac emergencies (def ibr i l lator ) mus t be
always avai lable.
Flexible bronchoscopy is an ext remely safe
procedure wi th a low incidence of compl icat ions .
Major l i fe threatening compl icat ions include
respiratory depression, pneumonia, pneumothorax, airway
obstruction, cardio-respiratory arrest, arrhythmias and
pulmonary edema. Major compl icat ions are par t ly
because of the cardiovascular effects of bronchoscopy,
leading to an increase in blood pressure and hear t
rate causing arrhythmias and cardiovascular ischemia.
Oxygen desaturat ion can occur because of the
procedure i tsel f or respi ratory depression by sedat ive
drugs leading to hypoxemia and increased r isk of
ar rhythmias and ischemia r igid bronchoscopy.
Minor non- l i fe threatening compl icat ions
include, in order of f requency, vasovagal react ions ,
fever , cardiac ar rhythmias, hemor rhage, nausea and
vomi t ing. Post -bronchoscopy fever occurs in
approximately 5-16% of the patients, with pulmonary
inf i l t rate occur r ing in 0.6% of al l cases . The sel f -
l imi t ing fever is usual ly not indicat ive of pneumonia
and may be due to t ransient bacteremia, t ranslocat ion
of endotoxins or r elease of inf lammatory mediators.
Uses of flexible fiberoptic bronchoscopy in ICU
(94)
References
Arora S, Miskovic D, Hul l L, Moorthy K,
Aggarwal R, Johannsson H, Gautama S,
Kneebone R, Sevdal is N, (2011) : Sel f vs exper t
assessment of technical and non - technical ski l ls in
high f idel i ty simulat ion. Amr J Surg 202(4) : 500 -
506.
Azoulay E, Mokart D, Lambert J, Lemiale V,
Rabbat A, Kouatchet A, Vincent F, Gruson D,
Bruneel F, Branche EG, Lafabrie A, Roy HR,
Cracco C, Renard B, Tonnel ier JM, Blot F,
Chevret S, Schlemmer B, (2010) : Diagnost ic
st rategy for hematology and oncology pat ients
wi th acute respi ratory fai lure: randomized
cont rol led t r ial . Am J Respi r Cr i t Care Med 182:
1038-1046.
Berkenbosch JW, Graf f GR, Stark JM, Ner Z,
Tobias JD. (2004) : Use of a Remi fentani l -
Propofol Mixture for Pediat r ic Flexible Fiberopt ic
Bronchoscopy Sedat ion. Pediat r ic Anaesthesia;14
(11) : 941-946.
Uses of flexible fiberoptic bronchoscopy in ICU
(95)
Berzin TM, Sanaka S, Barnet t SR, Sundar E,
Sepe PS, Jakubowski M et al (2011) : A
prospect ive assessment of sedat ion related adverse
events and pat ient and endoscopist sat isfact ion in
ERCP wi th anesthesiologist - administered sedat ion.
Gas t rointest Endosc 73(4) :710–717.
Boules R, Szkiladz A, Nogid A. (2012):
Fospropofol disodium (lusedra) injection for
anesthesia-care sedation: a clinical review. P.T.; 37:
395–422.
Carmi U, Kramer MR, Zemtzov D, Rosengarten
D, Fruchter O (2011) : Propofol safety in
bronchoscopy: prospect ive randomizedt