Bronchoscopic Procedures

Abstract

Diagnostic flexible bronchoscopy is safely performed outside of the operating room with light to moderate sedation and topical anesthesia. Rigid bronchoscopy is typically performed in patients with central airway obstruction and major comorbidities. Primary concerns include the risk of complete airway obstruction and inability to ventilate or dynamic hyperventilation with hemodynamic compromise. A fluid transition between ventilation strategies is often required for these procedures. Extracorporeal membrane oxygenation may be implemented when conventional approaches are not feasible or deemed safe. Multimodal techniques employed by interventional bronchoscopists to acutely re-establish patency of obstructed central airways include stenting, laser, endobronchial electrosurgery, argon plasma coagulation, and balloon bronchoplasty. Major intraoperative complications associated with these techniques include hemorrhage, airway trauma, perforation, fire, systemic gas embolism, and dissemination of postobstructive pneumonia. Alternative indications for these procedures include treatment of low-grade malignancies and carcinoma in situ. These lesions may also respond to brachytherapy, cryotherapy, or photodynamic therapy. Interventional bronchoscopy is an evolving field with expanding applications with both diagnostic and therapeutic modalities covering benign and malignant pulmonary disease. Future indications may include endobronchial valve insertion for persistent air leaks and lung volume reduction in COPD as well as bronchial thermoplasty for treatment-resistant asthma.