Role of Toilet Bronchoscopy in RICU

  • End date
    Jul 27, 2023
  • participants needed
  • sponsor
    Assiut University
Updated on 27 April 2022
chest x-ray
chronic obstructive pulmonary disease
pulmonary disease
assisted ventilation
fiberoptic bronchoscopy


Toilet bronchoscopy is a potentially therapeutic intervention to aspirate retained secretions within the endotracheal tube and airways and revert atelectasis. Aspiration of airway secretions is the most common indication to perform a therapeutic bronchoscopy in the intensive care unit (ICU) .

Toilet bronchoscopy is particularly beneficial when retained secretions are visible during the procedure and when air-bronchograms are not present at the chest radiograph. It is also beneficial when there is an indication to reverse lobar atelectasis, rather than simply to remove accumulated mucus.

Toilet bronchoscopy is used in lobar and complete lung collapse in mechanically ventilated patients who fail to respond to treatments such as physiotherapy or recruitment manoeuvres.

The success rates (defined as radiographic improvement on chest X-ray [CXR] or an improved PaO2/PAO2 ratio) in the ICU patient population had.

Patients with acute hypoxaemic respiratory failure may already be on non-invasive ventilation (NIV), or require NIV preemptively for Fiberoptic Bronchoscopy (FB). These patients should be considered high risk for requiring intubation post-procedure; therefore, Fiberoptic Bronchoscopy should be performed by an experienced operator in a setting allowing facilities to safely secure the airways. NIV with early therapeutic FB rather than mechanical ventilation can help avoid intubation and reduce tracheostomy rate. Hospital mortality, duration of ventilation, and hospital stay remain similar


Aim Of Work To study the value of toilet bronchoscopy in

  1. Mechanical ventilated patients with chest disease and copious secretion.
  2. Mechanical ventilated patients diagnosed to have atelectasis radiologically.
  3. Patients on non-invasive ventilation with chest diseases and copious secretion
  4. Compare Different types of mucolytics during toilet bronchoscopy in mechanically ventilated patients.
  5. Compare Different types of sedations during toilet bronchoscopy in mechanically ventilated patients.

Condition COPD, Asthma, Cystic Fibrosis
Treatment toilet bronchoscope
Clinical Study IdentifierNCT04798118
SponsorAssiut University
Last Modified on27 April 2022


Yes No Not Sure

Inclusion Criteria

• Patients on mechanical ventilation with underlying dieases that are characterized with mucus overproduction such as asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and cystic fibrosis
Patients on mechanical ventilation with visible large amount of sputum during suction in order to clear secretions
Patients on mechanical ventilation with radiologically diagnosed atelectasis and absent air-bronchograms
Patient on NIV who was benefit from toilet bronchoscopy to clear retained secretion

Exclusion Criteria

Absolute contraindications
Absence of consent from the patient or his/her representative
Inability to adequately oxygenate the patient during the procedure
Current myocardial ischaemia
Significant haemodynamic instability
Life-threatening cardiac arrhythmias
Current significant bronchospasm
Undrained pneumothorax
Relative contraindications
Thrombocytopenia (platelet count ≤50,000 platelets/mm)
INR of 2 or greater, or an elevated PTT
BUN >30\
severe tracheal obstruction
Recent myocardial ischaemia and/or unstable angina
Intracranial hypertension
Poorly-controlled heart failure
Recent oral intake
Clear my responses

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