Indications for Flexible Fiberoptic Bronchoscopy
Procedure | Indication |
|---|---|
Diagnostic | Abnormal chest radiograph: To diagnose the etiology of pneumonia* in a patient who is immunocompromised; in a patient who is immunocompetent and has recurrent or nonresolving disease; or in a patient with a paratracheal/mediastinal/hilar mass, parenchymal mass, or nodule, especially in a proximal lung section Atelectasis (persistent)* Cough (persistent, unexplained)* Diffuse lung process (transbronchial lung biopsy) Evaluation for rejection in a recipient of a lung transplant Evaluation of airway in a patient with burns Evaluation for bronchial disruption in a patient with chest trauma Positive sputum cytology in a patient with a normal chest radiograph* Suspected tracheoesophageal fistula Wheeze (localized/fixed) |
Therapeutic† | Aspiration of retained secretions*, ‡ Bronchopulmonary lavage (pulmonary alveolar proteinosis) Laser resection of tumor§ Lung volume reduction Management of bronchopleural fistula Photodynamic therapy§ Placement of an airway stent§ Placement of endotracheal tube in a difficult situation (cervical injury, abnormal anatomy) Placement of an endobronchial valve Removal of foreign body§ |
* Flexible fiberoptic bronchoscopy is indicated only after failure of less invasive investigations and treatments. | |
† Criner GJ, Eberhardt R, Fernandez-Bussy S, et al. Interventional Bronchoscopy. Am J Respir Crit Care Med. 2020;202(1):29-50. doi:10.1164/rccm.201907-1292SO | |
‡ Flexible fiberoptic bronchoscopy is not a substitute for chest physiotherapy, bronchodilator nebulization, and nasotracheal suctioning; it should be reserved for hypoxemia (in a patient receiving mechanical ventilation) and/or lobar atelectasis secondary to impacted secretions refractory to conventional therapy. | |
§ Rigid bronchoscopy provides more control for instrumentation than flexible bronchoscopy. | |