The indications for a bronchoscopy are many. The object in each setting is
- For Endobronchial Symptoms or Signs
Symptoms and signs of endobronchial disease are the most common indications for a
- Chronic cough
- Obstructive pneumonia
- Localized wheezing
- Lung Cancer:
Lung cancer is one of the most common conditions where a bronchoscopy is indicated. It is
- Tissue diagnosis
- Early diagnosis
Patients who sustained burns and suspected of having injuries to the respiratory passages
- Assessment of the Endotracheal Tube Position:
- Removal of Foreign Body:
In general, foreign body removal is best done with a rigid bronchoscopy under general
A fiberoptic bronchoscopy may be used as a screening
procedure for suspected cases of aspiration. Patients with known or suspected foreign
bodies should undergo a rigid bronchoscopy. If the evidence for aspiration is equivocal,
patients should undergo a diagnostic flexible bronchoscopy, and then a rigid bronchoscopy
if a foreign body is found.
There have been reports of foreign body extraction using flexible bronchoscopes,
but this is poorly suited for such work. I discourage its use for this purpose.
Let me show you a chest x-ray of a patient who aspirated a tooth. One of my
colleagues successfully removed it with a fiberoptic bronchoscopy.
- Hiller, C, et al. Foreign body removal with the flexible fiberoptic
- Wood, RE, et al. Flexible fiberoptic bronchoscopy in the management of
tracheobronchial foreign bodies in children: The value of a combined approach with open
tube bronchoscopy. J of Ped Surg 19:693-8, 1984.
- Zxavala, DC, et al. Foreign body removal. A new role for the fiberoptic
bronchoscope. Ann Otol 84:650-____, 1975.
- Lung Abscess:
To Rule out Endobronchial Lesion and for Drainage
- Tracheal Stenosis:
- Refractory Atelectasis: With a Balloon Cuff
- Respiratory Toilette:
Occasionally, a bronchoscopy will be indicated for respiratory toilette. As a general
rule, postural drainage, tapotage, cough and suction of secretions are sufficient. If for
some reason these cannot be done, then bronchoscopy can be done for respiratory toilette.
Prospective studies have shown that a good intensive respiratory toilette can accomplish
good results in the control of atelectasis. However, there are many clinical circumstances
when respiratory toilette cannot ideally be accomplished. They are as follows:
- Spine injury
- Balloon pump
- Left lower lobe atelectasis
Blind passage of the catheter to the left lower lobe is difficult. Hence, the
poor success rate with respiratory toilette with lower lobe atelectasis.
Staff availability on weekends for providing respiratory toilette is a problem
and one is forced to resort to doing a bronchoscopy. While a bronchoscopy is relatively
simple, it should not, in any way, replace the general principles of respiratory toilette.
- Stevens, RP, et al. Fiberoptic bronchoscopy in the intensive care unit. Heart and
Lung 10:1037-45, 1981.
- Barret, R. Flexible bronchoscopy in the critically ill patient. Methodology and
Indications 73:746-9, 1978.
Preliminary to Other Procedures