Modalities of fiberoptic bronchoscopy in the critically ill non-intubated hypoxemic patients

Despite the development of non-invasive diagnostic tools, bronchoscopy with bronchoalveolar lavage (FB-BAL) still plays a key role in the diagnostic challenge faced while managing patients admitted to the intensive care unit with acute hypoxemic respiratory failure. FB-BAL often represents the most helpful test to assess the final diagnosis and to allow targeting treatments and reducing their side-effects. FB-BAL should be performed in selected patients by trained physicians. To be beneficial, FB-BAL should be integrated into a clear diagnostic strategy and its benefits balanced with its possible risks in the hypoxemic patients. Several studies have assessed that FB-BAL is safe even in spontaneously breathing hypoxemic patients. In these patients, non-invasive positive pressure ventilation has been shown to prevent any worsening in respiratory conditions and avoid tracheal intubation in comparison to conventional oxygen supply. Sedation was suggested to additionally improve FB-BAL safety.