Interventional pulmonology in the intensive care unit

Abstract

The pulmonary physician plays a very important role in the intensive care unit (ICU). More recently, the interventional pulmonary physician has become very important in this area as well, where he/she is frequently requested to solve different situations, particularly those related to the airway and/or the pleura. Patients in the ICU are critically ill, and many of these procedures have to be performed at the bedside, to avoid the additional risks involved in transferring patients to the operating room. The bronchoscopist usually is required to perform bronchoalveolar lavage (BAL) samples to help diagnosing a pulmonary infection or for transbronchial lung biopsy in a patient on mechanical ventilation (MV). Less frequently, a transbronchial needle aspiration is needed, or a patient with hemoptysis is evaluated. These procedures are almost exclusively diagnostic. The most classic therapeutic intervention requested in the intensive care setting is the evaluation and treatment of persistent atelectasis. However, in the last few years, the role of the interventional pulmonologist in the ICU has broadened, and the number of procedures that the interventionists can perform has evolved. In this chapter, we will review different situations that can require assistance from the interventional pulmonology team. We will limit our discussion to airway-related problems.