From the Guidelines
Rigid bronchoscopy is recommended for patients with symptomatic malignant or nonmalignant central airway obstruction, as it provides better airway control and allows for ventilation during the procedure, according to the most recent guidelines 1. When performing rigid bronchoscopy, it is essential to follow proper protocols to minimize complications and ensure optimal outcomes.
Key Considerations
- The procedure should be performed under general anesthesia with the patient in a supine position and the neck extended, as this allows for better control of the airway and reduces the risk of complications 1.
- Preoxygenation and administration of appropriate anesthetic agents, such as propofol (1-2 mg/kg) and a muscle relaxant like rocuronium (0.6 mg/kg), are crucial for ensuring patient safety and comfort during the procedure.
- The rigid bronchoscope should be inserted through the mouth, past the vocal cords, and into the trachea with gentle, controlled pressure while visualizing the airway structures, to minimize the risk of trauma to the airway or surrounding tissues.
- Oxygenation should be maintained through the side port of the bronchoscope using jet ventilation (driving pressure 15-50 psi) or conventional ventilation, to ensure adequate oxygenation and ventilation during the procedure.
Indications and Contraindications
- The primary indications for rigid bronchoscopy include management of massive haemoptysis, treatment of tracheobronchial stenosis, foreign body removal, tumour resection, and deep bronchial-wall biopsy, as outlined in the European Respiratory Society/American Thoracic Society statement on interventional pulmonology 1.
- Contraindications specific to rigid bronchoscopy include an unstable cervical spine, severe maxillofacial trauma or deformity, or obstructing oral or laryngeal disease, as these conditions may increase the risk of complications during the procedure 1.
Training and Competency
- Training in rigid bronchoscopy should be reserved for physicians who have had extensive experience with flexible bronchoscopy and endotracheal intubation, and should include practice on mannequins or animal models, as well as supervised procedures 1.
- To maintain competency, the procedure should be performed at least 10–15 times/year, to ensure that the physician remains proficient in the technique and can provide optimal care for patients.
From the Research
Guidelines for Rigid Bronchoscope
- The use of muscle relaxants and traditional low-frequency ventilation can be safely applied in rigid bronchoscopy treatments for patients with central airway obstruction 2.
- Rigid bronchoscopy is an invaluable tool for the management of airway disorders, including central airway obstruction, foreign body aspiration, and massive hemoptysis 3.
- The main indication for rigid bronchoscopy in adult bronchology remains central airway obstruction due to neoplastic or non-neoplastic disease 4.
- Negative pressure ventilation (NPV) under general anesthesia can be used to prevent intraoperative apnea and respiratory acidosis during rigid bronchoscopy 4.
- Laser-assisted mechanical resection and stent placement are effective procedures for preserving quality of life in patients with advanced stage cancer 4.
- The dosage of skeletal muscle relaxants used was higher in rigid bronchoscopy compared with flexible bronchoscopy therapy 2.
- There is no significant difference in the occurrence of adverse events between rigid and flexible bronchoscopy therapy 2.
- Rigid bronchoscopy can be used to provide airway access and control in patients with central airway obstruction, and it has proved to be an excellent tool for palliative airway treatments 4.
- Interventional pulmonologists must have training and develop expertise in rigid bronchoscopy technique 3.