Bronchoscopy in the intensive care unit: when interventional pulmonology helps

C. Da Silva Alves*^a (Dr), L. Maia Morais^b (Dr), M. Alves^c (Dr), M. Ferrão Silveira^a (Dr), L. Santos^a (Dr), R. Costa^a (Dr), J. Boléo-Tomé^a (Dr), F. Rodrigues^a (Dr)

^a Pulmonology Department, Hospital Professor Doutor Fernando da Fonseca, Amadora, PORTUGAL ; ^b Intensive Care Unit, Centro Hospitalar Lisboa Ocidental, Lisboa, PORTUGAL ; ^c Pulmonology Department, Centro Hospitalar Lisboa Ocidental, Lisboa, PORTUGAL

* cmdsalves@gmail.com

Background: In some European countries like Portugal, Pulmonology and Intensive Care Medicine (IMC) are two different specialties. Intensivists have now training in flexible bronchoscopy, mainly with diagnostic purposes, occasionally referring more complex cases to Pulmonology.

Methods: Descriptive analysis of all bronchoscopy exams performed under mechanical ventilation by an interventional pulmonology team in an Intensive Care Unit (ICU). Medical records from January 2015 to December of 2021 were retrospectively reviewed (first 6 years since intensive care medicine is a recognized specialty in Portugal).

Results: Seventy endoscopic exams were reviewed, 61 (87%) flexible bronchoscopies (FB) and 9 (15%) rigid bronchoscopies (RB). There was a median of 10 exams performed per year, with a decrease during the covid-19 pandemic (3 in 2020 and 8 in 2021). Patients were mainly female (68%) with mean age of 62 ± 18 years. The main indications for FB were hemoptysis (n=16, 26%), suspected lung infection (n=10, 16%), diagnosis or staging of lung cancer (n=9, in which 3 were with radial EBUS) and lung atelectasis (n=9, 15%). Aspiration of bronchial secretions (n=57, 93%), bronchoalveolar lavage (n=23, 38%), bronchial toilette (n=10, 16%) and bronchial biopsy (n=8, 13%) were the most frequent techniques performed.

The indications for RB were hemoptysis (n=3, 33%), revision of tracheal (n=1, 11%) and bronchial (n=1, 11%) stent and benign tracheal stenosis (n=4, 44%), the latter following previous diagnostic FB performed due to stridor and leading to the placement of tracheal stents in all.

Conclusion: Although bronchoscopy training has been recently included in ICM programs, a negative trend in the number of endoscopic exams performed by pulmonology in ICU was not noted. Complex diagnostic and therapeutic cases need to be reffered to a dedicated bronchology team.

Disclosure of funding source(s): none