Suryani Padua Fatrullah¹, Yuni Iswati², Prasenohadi², Menaldi Rasmin²
- Departemen Pulmonologi dan Ilmu Kedokteran Respirasi, Fakultas Kedokteran Universitas Airlangga, Rumah Sakit Umum Daerah Dr. Soetomo, Surabaya
- Departemen Pulmonologi dan Ilmu Kedokteran Respirasi, Fakultas Kedokteran Universitas Indonesia, Rumah Sakit Persahabatan, Jakarta
Bronchoscopy is a relatively safe procedure and commonly performed in the intensive care unit (ICU). Preparation before bronchoscopy includes complete examination and preparing equipments for resuscitation and cardiorespiratory monitoring, and oxygen. Bronchoscopies can be performed in ICU by bronchoscopist and nursing staff with appropriate training. The indication for bronchoscopy in ICU can be diagnostic and therapeutic, and the common indication includes pneumonia, atelectasis, hemoptysis, bronchopleural fistula, and difficult intubation. In a non intubated patient bronchoscopy can be done through oral and nasal route, and in intubated patient with mechanical ventilator through ETT or tracheostomy with special valve. The diameter of ETT is at least 2 mm larger than the bronchoscope’s outer diameter. Ventilator mode is adjusted to mandatory setting, pressure-control or volume-control mode. Relative contraindications to bronchoscopy include severe respiratory insufficiency when bronchoscopy will be non therapeutic, inability to maintain a patent airway, severe cardiovascular instability, coagulopathy when biopsy is considered, and severe generalized debilitated status. Mortality rate of bronchoscopy is not more than 0.1% and complication rate is 8.1%. Complications include hypoxemia, desaturation, bleeding, cardiac arrest, fever and laryngospasm. Bronchoscopy in ICU needs careful consideration for risk and benefit of the procedure. (J Respir Indo. 2014; 34: 167-73)
Keywords: bronchoscopy, intensive care unit, mechanical ventilation.