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

Question

a. Risks are minimal since the patient already has a secured airway.
b. The resistance imposed by the broncho-scope may cause tracheal pressures to in-crease noticeably.
c. Albuterol should be available to address and airway resistance changes.
d. Inspiratory and expiratory effort (meas-ured by tracheal pressure) appears mini-mally affected in most patients.

Answer 1

ANS: B
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 aver-ages 14 mm in women and 18 mm in men. Thus, in nonintubated, spontaneously breathing pa-tients inspiratory and expiratory effort (measured by tracheal pressure) appears minimally affect-ed in most patients (−5 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 (−10 and +9 cm H2O) and may reach clinically unacceptable levels (−20 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.