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World J Crit Care Med. Nov 9, 2021; 10(6): 334-344
Published online Nov 9, 2021. doi: 10.5492/wjccm.v10.i6.334
Role of bronchoscopy in critically ill patients managed in intermediate care units - indications and complications: A narrative review
Vincenzo G Menditto, Federico Mei, Benedetta Fabrizzi, Martina Bonifazi
Vincenzo G Menditto, Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
Federico Mei, Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
Benedetta Fabrizzi, Cystic Fibrosis Regional Reference Center, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
Martina Bonifazi, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona 60126, Italy
Author contributions: All authors wrote, read, and approved the final manuscript.
Conflict-of-interest statement: Authors certify that there is no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vincenzo G Menditto, PhD, Doctor, Medical Assistant, Postdoc, Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy. vincenzomenditto74@yahoo.it
Received: May 15, 2021
Peer-review started: May 15, 2021
First decision: June 5, 2021
Revised: June 18, 2021
Accepted: August 18, 2021
Article in press: August 18, 2021
Published online: November 9, 2021
Abstract

Flexible bronchoscopy (FB) has become a standard of care for the triad of inspection, sampling, and treatment in critical care patients. It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit (ICU). Less is known about its role outside the ICU, particularly in the intermediate care unit (IMCU), a specialized environment, where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided. In the IMCU, the leading indications for a diagnostic work-up are: To visualize airway system/obstructions, perform investigations to detect respiratory infections, and identify potential sources of hemoptysis. The main procedures for therapeutic purposes are secretion aspiration, mucus plug removal to solve atelectasis (total or lobar), and blood aspiration during hemoptysis. The decision to perform FB might depend on the balance between potential benefits and risks due to frailty of critically ill patients. Serious adverse events related to FB are relatively uncommon, but they may be due to lack of expertise or appropriate precautions. Finally, nowadays, during dramatic recent coronavirus disease 2019 (COVID-19) pandemic, the exact role of FB in COVID-19 patients admitted to IMCU has yet to be clearly defined. Hence, we provide a concise review on the role of FB in an IMCU setting, focusing on its indications, technical aspects and complications.

Keywords: Flexible bronchoscopy, Critically ill, Bronchoalveolar lavage, Indication, Complication, COVID-19

Core Tip: Less is known about the role of flexible bronchoscopy (FB) outside the intensive care unit, in particular in the intermediate care unit setting (IMCU). Here, we provide a concise review on the role of FB in IMCU settings, focusing on its indications, technical aspects and complications with a particular attention of its recent use in coronavirus disease 2019 patients. We reviewed the main diagnostic indications, such as viewing airway system/obstructions, detecting respiratory infections, and main therapeutic indications, such as secretion removal (toilet bronchoscopy) and manage hemoptysis.