I do not think there is any one absolute contraindication for a bronchoscopy.
However, there are many situations where special precautions must be taken. I will list
some commonly encountered high risk situations.
- Uncooperative Patient:
Uncooperative or mentally deranged patients are not suitable candidates for fiberoptic
bronchoscopy under local anesthesia. A bronchoscopy must be performed under general
anesthesia. This is not a contraindication for a bronchoscopy. However, it is an issue
regarding the type of anesthesia used.
- Acute Myocardial Infarction:
Recent myocardial infarction, unstable angina and serious dysarrhythmias are relative
contraindications for a bronchoscopy.
- C02 Retention:
C02 retention is a concern. If there is a strong indication for a bronchoscopy in a
chronic C02 retainer, a bronchoscopy can be performed without premedication or valium. The
Watch the patient closely and intubate if the need arises. The alternative is to intubate
the patient and perform the bronchoscopy under a controlled situation on a ventilator.
- Low PO2:
The inability to raise the pre-bronchoscopy P02 to 65 mm with supplemental oxygen is a
contraindication. This scenario can occur with patients on a ventilator who have ARDS like
- Coagulation Defect:
There is no contraindication for a bronchoscopy in patients with uremia or patients with a
known coagulation defect. Of course, there is a contraindication for brushing or biopsy.
Bronchoalveolar lavage can be done safely in these patients.
- Tracheal Stenosis:
You should be aware of the concept of "open" and "closed"
bronchoscopy. Fiberoptic bronchoscope is a closed bronchoscope, while the rigid
bronchoscope is an open scope. In patients with tracheal stenosis, be aware that if you go
beyond the stenosis with a fiberoptic bronchoscope, you could be completely occluding the
- Foreign Body:
If you are sure of the prescience of a foreign body, it is best to do a rigid bronchoscopy
under general anesthesia. If there is some doubt, you can use the bronchoscopy as a
Asthmatics can develop severe laryngospasm and bronchospasm during a bronchoscope. With
proper preparation, using steroids and bronchodilators, the procedure can be carried out
safely. I routinely give 200 mg of hydrocortisone the night before and immediately prior
to the procedure. The preprocedural administration of bronchodilating agents is an
important step in the prevention of complications.
- Summary and recommendations of a workshop on the investigative use of fiberoptic
bronchoscopy and bronchoalveolar lavage in individuals with asthma. J Allergy Clin Immunol
- Sahn, SA, et al. Fiberoptic bronchoscopy in bronchial asthma. A word of caution.
Chest 69:39-42, 1976.
- Nakhostemm, JA. Bronchofiberoscopy in asthmatics: A method for minimizing
complications. Respiration 36:112-6, 1978.
- SVC Syndrome:
Superior vena caval syndrome used to be considered a contraindication for a bronchoscopy.
The concerns are:
- Bleeding with the biopsy
- Tolerance of the supine position by the patient. I usually perform the
bronchoscopy in a sitting positions in patients with SVC. Patients seem to tolerate the
bronchoscopy in the sitting position quite well. I have not found bleeding to be a