Abstract

Flexible bronchoscopy (FOB) imparts an important role in modern ICU during management of critically ill patients. It is minimally invasive, can be performed at the patient’s bedside even in mechanically ventilated patients, allowing real- time visualization of airway and bronchi. Its utility spans diagnostic, therapeutic and procedural assistance, making it popular in a complex environment like ICU.

Flexible bronchoscopy can be introduced through the endotracheal tube and tracheostomy tube which has made this procedure invaluable in mechanically ventilated patients for timely decision making and targeted interventions.FOB visualizes structural abnormalities, airway patency and can remove any secretions, blood clots thus improves oxygenation and ventilation. Atelectasis from retained sputum can be sucked out by FOB to re-expand lung segments. It guides intubation during difficult airways, confirms the position & patency of tracheostomy tube hence reducing procedural complications.FOB can visualize airway infections, bleeding and foreign body aspiration. Bronchoalveolar lavage (BAL) and Protected specimen brush(PSB) performed to collect fluid for cytological or microbiological analysis in suspected ventilator associated pneumonia without contamination of upper airways. Hence, ICU stay and mortality could be decreased in ventilated patients by administering targeted antibiotics. Expert bronchoscopists can remove foreign bodies and tumors from the airways without the need of rigid bronchoscopy. FOB guided biopsy may be done to diagnose tumors. Localization and management of bleeding point by applying local measures eg. vasoconstrictors, argon plasma coagulation(APC), bronchial blockers are rewarding with the advent of FOB.

Advances in flexible bronchoscopy continue to redefine its role in ICU care. By integrating cutting-edge technologies such as Artificial Intelligence (AI), nanotechnology, regenerative medicine, FOB has become a cornerstone of modern critical care, offering innovative solutions to the most complex challenges faced by ICU doctors. FOB is sometimes hazardous in situations like uncontrolled hypoxemia, arrhythmia, inexperienced bronchscopist and unequipped suit. Common complications are bleeding, bronchospasm, worsening hypoxemia in severe respiratory failure. Purchasing and repairing the machine and probes are costly which is often burdensome for resource poor settings. FOB should be conducted by expert personnel like pulmonologists, trained intensivists or anesthesiologists to maximize its benefit.