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Toilet bronchoscopy in the ICU 

Toilet bronchoscopy in the ICU
Chapter:
Toilet bronchoscopy in the ICU
Author(s):

Gianluigi Li Bassi

and Carles Agusti

DOI:
10.1093/med/9780199600830.003.0122
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date: 25 February 2020

Critically-ill patients retain respiratory secretions. Toilet bronchoscopy is applied to aspirate retained secretions and revert lung atelectasis. Toilet bronchoscopy is particularly indicated when retained secretions are visible during the procedureand air-bronchograms are not present at the chest radiograph. Yet, toilet bronchoscopy should only be applied when other less invasive methods of secretion removal have failed. Ventilatory settings during the intervention, the inspiratory fraction of oxygen should be increased to 100%. In volume control ventilation, the pressure limit alarm needs to be increased; during pressure-controlled ventilation, the set inspiratory pressure should be increased. The external PEEP should be decreased to at least 50% of the baseline values, to prevent barotrauma. The use of sedatives, analgesics, and topical anaesthetics is mandatory to achieve favourable procedural condition. Toilet bronchoscopy is also feasible and safe in critically-ill patients undergoing non-invasive ventilation.

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