Utility of Immediate Postlobectomy Fiberoptic Bronchoscopy in Preventing Atelectasis

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

“…Most evidence regarding atelectasis treatment relies on uncontrolled, nonrandomized trials or observational studies [24]. Only two randomized trials, one of them including postlobectomy patients only, had compared FOB versus chest physiotherapy [25,26]. Due to the conflicting evidence FOB is generally reserved for certain circumstances regarding atelectasis.…”

Predictors of atelectasis after pulmonary lobectomy

“…Jaworski et al concluded that the intraoperative buildup of secretions was not the major cause of PLA, based on the fi nding that immediate postoperative bronchoscopy performed prophylactically did not prevent its occurrence because the critical point of bloody mucus buildup is usually 2-3 days after lobectomy. 13 The use of bronchoscopy to clear retained secretions has become a standard procedure for patients with atelectasis, with success rates ranging from 70% to 89%. 11,14 15 The possible risks of bronchoscopy include exacerbated hypoxemia, hypercapnia, and elevated end-inspiratory pressure.…”

British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE

“…One randomised trial has been conducted assessing the utility of bronchoscopy in the prevention of atelectasis in 29 patients, ventilated after thoracic surgery (lobectomy) 231. In this study, there was no difference in any outcome measured (including blood gases, spirometry, the need for further bronchoscopy, radiology, ICU and hospital stay) between those treated using bronchoscopy and those treated with suction and physiotherapy (standard care).…”