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Bedside Procedures for the Intensivist pp 255–273Cite as

Transbronchial Biopsy in the Intensive Care Unit

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Abstract

Since its introduction in 1968, the fiberoptic bronchoscope has had a remarkable impact in the diagnosis and management of patients with respiratory maladies.1 The physicians entrusted with the care of critically ill patients are often faced with an array of chest roentgenographic abnormalities for which flexible bronchoscopy (FB) can be a valuable diagnostic tool.

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References

  1. Sackner MA. Bronchofiberscopy. Am Rev Respir Dis. 1975;111(1):62–88.

    PubMed  CAS  Google Scholar 

  2. Papin TA, Grum CM, Weg JG. Transbronchial biopsy during mechanical ventilation. Chest. 1986;89(2):168–170.

    Article  PubMed  CAS  Google Scholar 

  3. Kao KC, Tsai YH, Wu YK, et al. Open lung biopsy in early-stage acute respiratory distress syndrome. Crit Care. 2006;10(4):R106.

    Article  PubMed  Google Scholar 

  4. Meduri GU, Chinn AJ, Leeper KV, et al. Corticosteroid rescue treatment of progressive fibroproliferation in late ARDS. Patterns of response and predictors of outcome. Chest. 1994;105(5):1516–1527.

    Article  PubMed  CAS  Google Scholar 

  5. Potter D, Pass HI, Brower S, et al. Prospective randomized study of open lung biopsy versus empirical antibiotic therapy for acute pneumonitis in nonneutropenic cancer patients. Ann Thorac Surg. 1985;40(5):422–428.

    Article  PubMed  CAS  Google Scholar 

  6. Folch E, Mehta AC. Airway interventions in the tracheobronchial tree. Semin Respir Crit Care Med. 2008;29(4):441–452.

    Article  PubMed  Google Scholar 

  7. Ovassapian A. Fiberoptic Airway Endoscopy in Anesthesia and Critical Care, vol. xix. New York: Raven Press; 1990:172.

    Google Scholar 

  8. Gaitini LA, Vaida SJ, Somri M, Fradis M, Ben-David B. Fiberoptic-guided airway exchange of the esophageal-tracheal combitube in spontaneously breathing versus mechanically ventilated patients. Anesth Analg. 1999;88(1):193–196.

    PubMed  CAS  Google Scholar 

  9. Milledge JS. Therapeutic fibreoptic bronchoscopy in intensive care. Br Med J. 1976;2(6049):1427–1429.

    Article  PubMed  CAS  Google Scholar 

  10. Grundling M, Pavlovic D, Kuhn SO, Feyerherd F. Is the method of modified percutaneous tracheostomy without bronchoscopic guidance really simple and safe? Chest. 2005;128(5):3774–3775.

    Article  PubMed  Google Scholar 

  11. Dweik RA, Stoller JK. Role of bronchoscopy in massive hemoptysis. Clin Chest Med. 1999;20(1):89–105.

    Article  PubMed  CAS  Google Scholar 

  12. Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med. 1990;112(8):604–609.

    PubMed  CAS  Google Scholar 

  13. Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest. 2005;128(6):3955–3965.

    Article  PubMed  Google Scholar 

  14. American Thoracic Society. Medical Section of the American Lung Association. Guidelines for fiberoptic bronchoscopy in adults. Am Rev Respir Dis. 1987;136(4):1066.

    Article  Google Scholar 

  15. Katz AS, Michelson EL, Stawicki J, Holford FD. Cardiac arrhythmias. Frequency during fiberoptic bronchoscopy and correlation with hypoxemia. Arch Intern Med. 1981;141(5):603–606.

    Article  PubMed  CAS  Google Scholar 

  16. Dweik RA, Mehta AC, Meeker DP, Arroliga AC. Analysis of the safety of bronchoscopy after recent acute myocardial infarction. Chest. 1996;110(3):825–828.

    Article  PubMed  CAS  Google Scholar 

  17. Diette GB, Wiener CM, White P Jr. The higher risk of bleeding in lung transplant recipients from bronchoscopy is independent of traditional bleeding risks: results of a prospective cohort study. Chest. 1999;115(2):397–402.

    Article  PubMed  CAS  Google Scholar 

  18. Ernst A, Eberhardt R, Wahidi M, Becker HD, Herth FJ. Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans. Chest. 2006;129(3):734–737.

    Article  PubMed  Google Scholar 

  19. Herth FJ, Becker HD, Ernst A. Aspirin does not increase bleeding complications after transbronchial biopsy. Chest. 2002;122(4):1461–1464.

    Article  PubMed  Google Scholar 

  20. Peerless JR, Snow N, Likavec MJ, Pinchak AC, Malangoni MA. The effect of fiberoptic bronchoscopy on cerebral hemodynamics in patients with severe head injury. Chest. 1995;108(4):962–965.

    Article  PubMed  CAS  Google Scholar 

  21. Kerwin AJ, Croce MA, Timmons SD, Maxwell RA, Malhotra AK, Fabian TC. Effects of fiberoptic bronchoscopy on intracranial pressure in patients with brain injury: a prospective clinical study. J Trauma. 2000;48(5):878–882; discussion 882–873.

    Article  PubMed  CAS  Google Scholar 

  22. Zavala DC. Pulmonary hemorrhage in fiberoptic transbronchial biopsy. Chest. 1976;70(5):584–588.

    Article  PubMed  CAS  Google Scholar 

  23. Bulpa PA, Dive AM, Mertens L, et al. Combined bronchoalveolar lavage and transbronchial lung biopsy: safety and yield in ventilated patients. Eur Respir J. 2003;21(3):489–494.

    Article  PubMed  CAS  Google Scholar 

  24. O’Brien JD, Ettinger NA, Shevlin D, Kollef MH. Safety and yield of transbronchial biopsy in mechanically ventilated patients. Crit Care Med. 1997;25(3):440–446.

    Article  PubMed  Google Scholar 

  25. Bahhady IJ, Ernst A. Risks of and recommendations for flexible bronchoscopy in pregnancy: a review. Chest. 2004;126(6):1974–1981.

    Article  PubMed  Google Scholar 

  26. Matot I, Kramer MR, Glantz L, Drenger B, Cotev S. Myocardial ischemia in sedated patients undergoing fiberoptic bronchoscopy. Chest. 1997;112(6):1454–1458.

    Article  PubMed  CAS  Google Scholar 

  27. Dunagan DP, Burke HL, Aquino SL, Chin R Jr, Adair NE, Haponik EF. Fiberoptic bronchoscopy in coronary care unit patients: indications, safety, and clinical implications. Chest. 1998;114(6):1660–1667.

    Article  PubMed  CAS  Google Scholar 

  28. Douketis JD, Berger PB, Dunn AS, et al. The perioperative management of antithrombotic therapy: American College of chest physicians evidence-based clinical practice guidelines (8th Edition). Chest. 2008;133(6 suppl):299S–339S.

    Article  PubMed  CAS  Google Scholar 

  29. Mehta NLMD, Harkin TJMD, Rom WNMD, Graap WET, Addrizzo-Harris DJMD. Should renal insufficiency be a relative contraindication to bronchoscopic biopsy? J Bronchol. 2005;12(2):81–83.

    Article  Google Scholar 

  30. Hedges SJ, Dehoney SB, Hooper JS, Amanzadeh J, Busti AJ. Evidence-based treatment recommendations for uremic bleeding. Nat Clin Pract. 2007;3(3):138–153.

    Article  CAS  Google Scholar 

  31. Livio M, Mannucci PM, Vigano G, et al. Conjugated estrogens for the management of bleeding associated with renal failure. N Engl J Med. 1986;315(12):731–735.

    Article  PubMed  CAS  Google Scholar 

  32. Jain P, Sandur S, Meli Y, Arroliga AC, Stoller JK, Mehta AC. Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates. Chest. 2004;125(2):712–722.

    Article  PubMed  Google Scholar 

  33. Cordasco EM Jr, Mehta AC, Ahmad M. Bronchoscopically induced bleeding. A summary of nine years’ Cleveland clinic experience and review of the literature. Chest. 1991;100(4):1141–1147.

    Article  PubMed  Google Scholar 

  34. Hanson RR, Zavala DC, Rhodes ML, Keim LW, Smith JD. Transbronchial biopsy via flexible fiberoptic bronchoscope; results in 164 patients. Am Rev Respir Dis. 1976;114(1):67–72.

    PubMed  CAS  Google Scholar 

  35. Bein T, Pfeifer M, Keyl C, Metz C, Taeger K. Right ventricular function and plasma atrial natriuretic peptide levels during fiberbronchoscopic alveolar lavage in critically ill, mechanically ventilated patients. Chest. 1995;108(4):1030–1035.

    Article  PubMed  CAS  Google Scholar 

  36. Davies L, Mister R, Spence DP, Calverley PM, Earis JE, Pearson MG. Cardiovascular consequences of fibreoptic bronchoscopy. Eur Respir J. 1997;10(3):695–698.

    PubMed  CAS  Google Scholar 

  37. Stolz D, Pollak V, Chhajed PN, Gysin C, Pflimlin E, Tamm M. A randomized, placebo-controlled trial of bronchodilators for bronchoscopy in patients with COPD. Chest. 2007;131(3):765–772.

    Article  PubMed  CAS  Google Scholar 

  38. Schweickert W, Hall J. Informed consent in the intensive care unit: ensuring understanding in a complex environment. Curr Opin Crit Care. 2005;11(6):624–628.

    Article  PubMed  Google Scholar 

  39. AARC clinical practice guideline. Fiberoptic bronchoscopy assisting. American Association for Respiratory Care. Respir Care. 1993;38(11):1173–1178.

    Google Scholar 

  40. American Association for Respiratory Care (AARC). Bronchoscopy assisting – 2007 revision and update. Respir Care. 2007;52(1):74–80.

    Google Scholar 

  41. Meduri GU, Chastre J. The standardization of bronchoscopic techniques for ventilator-associated pneumonia. Chest. 1992;102(5 Suppl 1):557S–564S.

    Article  PubMed  CAS  Google Scholar 

  42. Lindholm CE, Ollman B, Snyder JV, Millen EG, Grenvik A. Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients. Chest. 1978;74(4):362–368.

    Article  PubMed  CAS  Google Scholar 

  43. Lawson RW, Peters JI, Shelledy DC. Effects of fiberoptic bronchoscopy during mechanical ventilation in a lung model. Chest. 2000;118(3):824–831.

    Article  PubMed  CAS  Google Scholar 

  44. McArthur CD. AARC clinical practice guideline. Capnography/capnometry during mechanical ventilation – 2003 revision and update. Respir Care. 2003;48(5):534–539.

    PubMed  Google Scholar 

  45. Williams TJ, Nicoulet I, Coleman E, McAlaney C. Safety and patient acceptability of intravenous midazolam for fibre optic bronchoscopy. Respir Med. 1994;88(4):305–307.

    Article  PubMed  CAS  Google Scholar 

  46. Clarkson K, Power CK, O’Connell F, Pathmakanthan S, Burke CM. A comparative evaluation of propofol and midazolam as sedative agents in fiberoptic bronchoscopy. Chest. 1993;104(4):1029–1031.

    Article  PubMed  CAS  Google Scholar 

  47. Cowl CT, Prakash UB, Kruger BR. The role of anticholinergics in bronchoscopy. A randomized clinical trial. Chest. 2000;118(1):188–192.

    Article  PubMed  CAS  Google Scholar 

  48. Williams T, Brooks T, Ward C. The role of atropine premedication in fiberoptic bronchoscopy using intravenous midazolam sedation. Chest. 1998;113(5):1394–1398.

    Article  PubMed  CAS  Google Scholar 

  49. Yigla M, Oren I, Bentur L, et al. Incidence of bacteraemia following fibreoptic bronchoscopy. Eur Respir J. 1999;14(4):789–791.

    Article  PubMed  CAS  Google Scholar 

  50. Mehta AC, Prakash UB, Garland R, et al. American College of Chest Physicians and American Association for Bronchology [corrected] consensus statement: prevention of flexible bronchoscopy-associated infection. Chest. 2005;128(3):1742–1755.

    Article  PubMed  Google Scholar 

  51. Reichert WW, Hall WJ, Hyde RW. A simple disposable device for performing fiberoptic bronchoscopy on patients requiring continuous artificial ventilation. Am Rev Respir Dis. 1974;109(3):394–396.

    PubMed  CAS  Google Scholar 

  52. Benumof JL. Management of the difficult adult airway. With special emphasis on awake tracheal intubation. Anesthesiology. 1991;75(6):1087–1110.

    Article  PubMed  CAS  Google Scholar 

  53. Antonelli M, Conti G, Riccioni L, Meduri GU. Noninvasive positive-pressure ventilation via face mask during bronchoscopy with BAL in high-risk hypoxemic patients. Chest. 1996;110(3):724–728.

    Article  PubMed  CAS  Google Scholar 

  54. McGrath G, Das-Gupta M, Clarke G. Bronchoscopy via continuous positive airway pressure for patients with respiratory failure. Chest. 2001;119(2):670–671.

    Article  PubMed  CAS  Google Scholar 

  55. Anders GT, Johnson JE, Bush BA, Matthews JI. Transbronchial biopsy without fluoroscopy. A seven-year perspective. Chest. 1988;94(3):557–560.

    Article  PubMed  CAS  Google Scholar 

  56. de Fenoyl O, Capron F, Lebeau B, Rochemaure J. Transbronchial biopsy without fluoroscopy: a five year experience in outpatients. Thorax. 1989;44(11):956–959.

    Article  PubMed  Google Scholar 

  57. Milligan SA, Luce JM, Golden J, Stulbarg M, Hopewell PC. Transbronchial biopsy without fluoroscopy in patients with diffuse roentgenographic infiltrates and the acquired immunodeficiency syndrome. Am Rev Respir Dis. 1988;137(2):486–488.

    PubMed  CAS  Google Scholar 

  58. Puar HS, Young RC Jr, Armstrong EM. Bronchial and transbronchial lung biopsy without fluoroscopy in sarcoidosis. Chest. 1985;87(3):303–306.

    Article  PubMed  CAS  Google Scholar 

  59. Descombes E, Gardiol D, Leuenberger P. Transbronchial lung biopsy: an analysis of 530 cases with reference to the number of samples. Monaldi Arch Chest Dis. 1997;52(4):324–329.

    PubMed  CAS  Google Scholar 

  60. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med. 1999;160(2):736–755

    Google Scholar 

  61. Armstrong JR, Radke JR, Kvale PA, Eichenhorn MS, Popovich J Jr. Endoscopic findings in sarcoidosis. Characteristics and correlations with radiographic staging and bronchial mucosal biopsy yield. Ann Otol Rhinol Laryngol. 1981;90(4 Pt 1):339–343.

    PubMed  CAS  Google Scholar 

  62. Roethe RA, Fuller PB, Byrd RB, Hafermann DR. Transbronchoscopic lung biopsy in sarcoidosis. Optimal number and sites for diagnosis. Chest. 1980;77(3):400–402.

    Article  PubMed  CAS  Google Scholar 

  63. Killeen D, Chin R, Conforti J. Bronchoscopic myths and legends. Clin Pulm Med. 2005;12(1):53–55.

    Article  Google Scholar 

  64. Frazier WD, Pope TL Jr, Findley LJ. Pneumothorax following transbronchial biopsy. Low diagnostic yield with routine chest roentgenograms. Chest. 1990;97(3):539–540.

    Article  PubMed  CAS  Google Scholar 

  65. Fulkerson WJ. Current concepts. Fiberoptic bronchoscopy. N Engl J Med. 1984;311(8):511–515.

    Article  PubMed  CAS  Google Scholar 

  66. Dellinger RP, Bandi V. Fiberoptic bronchoscopy in the intensive care unit. Crit Care Clin. 1992;8(4):755–772.

    PubMed  CAS  Google Scholar 

  67. Shelley MP, Wilson P, Norman J. Sedation for fibreoptic bronchoscopy. Thorax. 1989;44(10):769–775.

    Article  PubMed  CAS  Google Scholar 

  68. Wimberley N, Willey S, Sullivan N, Bartlett JG. Antibacterial properties of lidocaine. Chest. 1979;76(1):37–40.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Sheikh Khalifa Medical City managed by Cleveland Clinic, Abu Dhabi, UAE

    Atul C. Mehta

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  1. Erik E. Folch
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  2. Chirag Choudhary
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  3. Sonali Vadi
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  4. Atul C. Mehta
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Correspondence to Atul C. Mehta .

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  1. Penn State Hershey Medical Center, 500 University Drive, Hershey, 17033-0850, USA

    Heidi L. Frankel

  2. Health Sciences Center, Louisiana State University, Perdido St. 1901, New Orleans, 70112, USA

    Bennett P. deBoisblanc

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Folch, E.E., Choudhary, C., Vadi, S., Mehta, A.C. (2010). Transbronchial Biopsy in the Intensive Care Unit. In: Frankel, H., deBoisblanc, B. (eds) Bedside Procedures for the Intensivist. Springer, New York, NY. https://doi.org/10.1007/978-0-387-79830-1_13

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  • DOI: https://doi.org/10.1007/978-0-387-79830-1_13

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