During bronchoscopy of an intubated patient receiving mechanical ventilation, what should the RT be aware of?

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Quizplus · Accepted Answer

The external diameter of a standard fiberoptic bronchoscope is 5.7 mm, but in some situations a smaller (5 mm or less) or larger (6.4 mm) diameter scope may be used. The narrowest point in the upper airway (and point of maximal resistance) is the cricoid space, the diameter of which averages 14 mm in women and 18 mm in men. Thus, in nonintubated, spontaneously breathing patients inspiratory and expiratory effort (measured by tracheal pressure) appears minimally affected in most patients (F1F1F1S1F1F1F105 and +3.5 cm H₂O, respectively). However, in intubated, spontaneously breathing patients, the resistance imposed by the bronchoscope may cause tracheal pressures to increase noticeably (F1F1F1S1F1F1F1010 and +9 cm H₂O) and may reach clinically unacceptable levels (F1F1F1S1F1F1F1020 and +20 cm H₂O) in some patients.⁶⁸ Therefore, the minimum appropriately sized endotracheal tube for a standard 5.7-mm bronchoscope is an 8.0-mm inner diameter.

During Bronchoscopy of an Intubated Patient Receiving Mechanical Ventilation, What