How do you mitigate risk when performing bronchoscopy in hypoxic patients requiring high levels of supplemental oxygen?

The first question you have to ask yourself, is 'why am I doing this'? If the answer is not going to significantly alter management (i.e. removal of a foreign body, bronchus plug; or biopsy to alter drug therapy) then it would be wise to defer until the patient is more stable.

If it is deemed the procedure is necessary, then there are some things you can attempt.

First, informed consent should center on the perils surrounding hypoxia so patients and their surrogates can understand the risks at p...

Diagnostic bronchoscopy can generally be performed safely in patients with hypoxemia even if requiring high levels of O2 but the bronchoscopist should be prepared to manage worsening hypoxemia with intubation and mechanical ventilation during the procedure if necessary. I typically have an endotracheal tube and mechanical ventilator available in such cases but rarely have had to use them. In therapeutic bronchoscopy, I will often intubate the patient first and then proceed with the procedure. Th...