Bronchoscopy to collect sputum in emergency resuscitation

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Article by Master, Doctor Le Thai Bao - Department of Intensive Care - Vinmec Times City International Hospital

1. What is bronchoscopy?

Bronchoscopy is a procedure performed by inserting a bronchoscope with a camera into the airways. Bronchoscopy is widely used to diagnose and treat many respiratory diseases.
In the emergency resuscitation unit, bronchoscopy can be used to clear the airways by aspirating sputum, bronchial obstruction.... Combined with clearing the airways, the procedure This can help with specimen collection or preliminary diagnosis of respiratory tract morphology.
Bronchoscopy to remove sputum plug is not a substitute for conventional sputum aspiration techniques, daily respiratory therapy such as vibrating, turning, breathing exercises...

2. When is bronchoscopy indicated?

The doctor usually appoints bronchoscopy patients in the following cases:
The patient is being treated in the intensive care unit, may or may not have been intubated, increased sputum secretion, weak cough. Chest radiographic evidence of atelectasis Respiratory status worsening or not improving Obtain diagnostic specimens

3. Contraindications for bronchoscopy

Absolute contraindications:
Uncontrollable life-threatening arrhythmia Unable to maintain the patient's oxygen status at a safe level during the procedure Acute respiratory failure with hypercapnia (except in in case of endotracheal intubation). Relative contraindications:
For unintubated but uncooperative patients who have had a recent myocardial infarction Severe endotracheal obstruction (requiring replacement) Uncontrolled coagulopathy

4. Bronchoscopy procedure to collect sputum in emergency resuscitation

Step 1: Prepare
Patient: You need to fast before 4 hours, the doctor will explain to the patient and family about the procedure. The patient signs a commitment to the procedure and is vacuumed sputum and sputum in the airways and mouth. Means and equipment: Prepare oxygen, Ambu mask with bag, suction tube, suction machine, endotracheal intubation kit: Light, guide , endotracheal tube, endotracheal tube 3 different sizes: 1 tube of current size, 1 tube with smaller diameter and 1 tube with diameter larger than 0.5 cm. Atropine 0.25 mg (3 ampoules), Midazolam 5 mg (2 ampoules), Lidocaine 1% spray or gel. Sodium chloride 0.9% (500ml). Endoscope and endoscope, suction equipment, take samples if necessary. Monitor to monitor breathing, heart rate, blood pressure Step 2: Steps to take
Final confirmation that all instruments are ready Squeeze the balloon through the old endotracheal intubation with oxygen > 10 liters/min, achieve SpO2 100% Oral suction pharynx Intravenously, or intramuscularly Atropin 0.01 mg/kg to reduce secretion and reduce hypervagal reflex Intravenous sedative Midazolam 5mg x 1 ampoule

Local anesthetic with lidocaine spray or lidocaine gel Insert the bronchoscope through the nose and mouth with the patient not intubated. For patients who have been intubated, bronchoscopes can be placed normally with an endotracheal tube size ≥ 8mm, moving the bronchoscope will be more convenient than Irrigation with 0.9% sodium chloride and aspirating sputum and secretions airways Chest X-ray to check after sputum aspiration. Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in neurological examination and treatment, patients can completely rest in peace. Center for examination and treatment at the Hospital.
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