Options of Introduction

There are many ways the fiberoptic bronchoscope can be introduced. An awareness of these alternatives is important. Each method has its own unique advantage. The anesthetic procedure will vary depending on the method you have selected.

The size of the bronchoscope and the endotracheal tube are important considerations. You need a size 8 tube and larger with a bronchoscope 5.5 mm in diameter. With smaller tubes, the peak pressures developed by the ventilator become excessive. The risk of pneumothorax becomes higher.

Prior to bronchoscopy, you should increase the oxygen concentration to 100% and increase the tidal volume to account for a leak. The procedure should be done intermittently.

If the endotracheal tube is smaller than 8 mm, we have three options: Reintroduce a larger ET tube, use a pediatric bronchoscopy or try introducing the bronchoscope along the side of the ET tube.


  1. Barret, CR. Flexible fiberoptic bronchoscopy in the critically ill patient. Chest 73:746-9, 1978.
  2. Feldman, NT, et al. An alternate method for fiberoptic bronchoscopic examination of the intubated patient. AARD 111:562-3, 1975.