Single-Use and Reusable Flexible Bronchoscopes in Pulmonary and Critical Care Medicine

Abstract

Flexible bronchoscopy plays a critical role in both diagnostic and therapeutic management of a variety of pulmonary disorders in the bronchoscopy suite and the intensive care unit. In the set-ting of the ongoing viral pandemic, single-use flexible bronchoscopes (SUFB) have garnered attention as various professional pulmonary societies have released guidelines regarding uses for SUFB given the concern for risk of viral transmission when using reusable flexible bronchoscopes (RFB). In addition to offering sterility, SUFBs are portable, easily accessible, and may be more cost-effective than RFB when considering the potential costs of treating bronchoscopy-related infections. Furthermore, since SUFBs are one time use, they do not require reprocessing after use, and therefore may translate to reduced cleaning and storage costs. Despite these advantages, RFBs are still routinely used to perform advanced diagnostic and therapeutic bronchoscopic procedures given the need for optimal maneuverability, handling, angle of deflection, image quality, and larger channel size for passing of ancillary instruments. Here, we review the published evidence on the applications of single-use and reusable bronchoscopes in bronchoscopy suites and intensive care units. Specifically, we will discuss the advantages and disadvantages of these devices as pertinent to fundamental, advanced, and therapeutic bronchoscopic interventions.

Performance of a new single-use bronchoscope versus a marketed single-use comparator: a bench study

“…Although rigid bronchoscopy may be indicated for massive hemoptysis or other specific therapeutic circumstances [ 4 ], flexible bronchoscopy has replaced rigid bronchoscopy for many diagnostic and therapeutic uses in patients without contraindications (uncorrectable hypoxemia, uncontrolled arrhythmias, lack of proper equipment and skilled personnel) [ 16 ]. The portability, immediate availability, and theoretical reduced risk of clinically relevant infections confer an advantage of using single-use over reusable flexible bronchoscopes in certain scenarios in the bronchoscopy and intensive care units [ 17 ]. However, because studies have not been performed comparing single-use versus reusable bronchoscopes in complex bronchoscopic procedures, a 2022 systematic review recommended that use of single-use bronchoscopes should be limited to flexible bronchoscopic intubation, simple therapeutic aspirations, BAL, and in low-risk percutaneous tracheostomy procedures until further evidence for more widespread use becomes available [ 17 ].…”

“…The portability, immediate availability, and theoretical reduced risk of clinically relevant infections confer an advantage of using single-use over reusable flexible bronchoscopes in certain scenarios in the bronchoscopy and intensive care units [ 17 ]. However, because studies have not been performed comparing single-use versus reusable bronchoscopes in complex bronchoscopic procedures, a 2022 systematic review recommended that use of single-use bronchoscopes should be limited to flexible bronchoscopic intubation, simple therapeutic aspirations, BAL, and in low-risk percutaneous tracheostomy procedures until further evidence for more widespread use becomes available [ 17 ].…”

Single-Use or Disposable Flexible Bronchoscopy in Advanced Bronchoscopy Procedures: Experience in a Quaternary Referral Centre

“…The cost-effectivity of SUFBs therefore not only depends on this risk of infection but also the number of procedures a year (the more procedures, the more cost-effective reusable scopes are). In a similar fashion to cost-effective analysis, however, most trials in the utility of single-use bronchoscopes were carried out in the ICU using AMBU ® scopes with in-general satisfaction with performance [1][2][3][4].…”

“…The development of disposable or single-use flexible bronchoscopes (SUFBs) has accelerated in recent years. SUFBs were initially developed for the intensive care unit (ICU) environment, particularly for intubation, difficult airway management, suction, and microbiological sampling [1][2][3][4]. Prior to the COVID-19 pandemic, publications regarding the risk of infection and high level of human protein and DNA contamination in reusable bronchoscopy raised significant concern in the pulmonary 932 DOI: 10.1159/000526214 field [5] in parallel with a global recommendation to switch from reusable to single-use medical devices where feasible [6].…”

Untitled

“…The emergence of single-use endoscopes for GI endoscopy is a relatively new phenomenon,73 while there is more data available for other indications (eg, endotracheal intubation, bronchoscopy and cystoscopy) 74 75. The avoidance, wherever possible, of the use of new (‘virgin’) plastics is a general central tenetof environmental sustainability 76.…”