From the Guidelines
Bronchoscopy in patients with acute chest crisis should be performed with extreme caution and only when absolutely necessary, as it carries significant risks that can worsen respiratory distress and trigger complications. The decision to proceed with bronchoscopy in such patients must be made carefully, weighing the potential benefits against the risks, and considering the patient's overall clinical condition and stability. When bronchoscopy is deemed necessary, several key precautions are essential to minimize risks:
- Ensure the patient is stabilized with optimal oxygenation before the procedure, using oxygen supplementation to achieve an oxygen saturation of at least 90% 1.
- Have resuscitation equipment immediately available, as well as skilled personnel, including an experienced bronchoscopist and an anesthesiologist if possible.
- Consider prophylactic bronchodilators like albuterol to prevent bronchospasm, especially in asthmatic patients 1.
- Use minimal sedation to avoid respiratory depression, titrating sedatives carefully and monitoring the patient's response closely 1.
- Monitor oxygen saturation continuously during and after the procedure, and be prepared to address any signs of respiratory failure or carbon dioxide retention 1.
- Post-procedure, close monitoring is crucial for at least 24 hours to detect any deterioration in the patient's condition.
Given the potential for bronchoscopy to trigger inflammatory responses and mechanical irritation in airways already compromised by acute chest crisis, less invasive diagnostic methods should be considered first whenever possible. The most recent and highest quality guidelines emphasize the importance of careful patient selection, thorough preparation, and meticulous monitoring during bronchoscopy in high-risk patients, such as those with acute chest crisis 1. By prioritizing these precautions and considering the individual patient's risk profile, healthcare providers can minimize the risks associated with bronchoscopy in acute chest crisis and optimize patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Safety of Bronchoscopy in Acute Chest Crisis
- Bronchoscopy is a relatively safe procedure, but careful consideration of the risks is necessary to minimize potential complications 2.
- The procedure carries a high risk of infection transmission to healthcare workers and other patients, especially during the COVID-19 pandemic 3.
- In patients with a history of choking crisis, bronchoscopy should be performed even if they have normal radiologic findings and few symptoms 4.
Precautions for Bronchoscopy in Acute Chest Crisis
- Strategies for minimizing thromboembolic and operative bleeding events need to be included in the risk and benefit analyses 2.
- Topical anesthesia, analgesia, and sedation are suggested in all patients undergoing bronchoscopy to enhance patient tolerance and satisfaction 5.
- Platelet transfusion may not be necessary for patients with platelets ≥10 K/μL undergoing bronchoscopy with lavage 6.
- The nasal route for bronchoscopy can be used safely in the absence of nasal bleeding, trauma, or deformity 6.
- Judicious case selection and meticulous contact and airborne precautions are important to minimize infection transmission during the COVID-19 pandemic 3.