Chief of Pulmonary and Critical Care Medicine Hackensack Meridian Health Hackensack University Medical Center
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Introduction: Bronchoscopy plays a unique role in managing critically ill patients in the intensive care unit (ICU). The therapeutic role of bronchoscopy in treating atelectasis by removal of thick mucus plugs, clearance of active bleeding or large blood clots can be lifesaving. With single-use flexible bronchoscopes (SUFB) becoming more commonly used in the ICU and with so many different bronchoscopes in the market, comparison of the different bronchoscopes, specifically in its suction capabilities remains a high priority.
Methods: An assessment of the three largest bronchoscopes from three different companies, Boston Scientific EXALT bronchoscope, Verathon Glidescope, and Ambu aScope were tested in a series of tests to determine its ability to suction both “pseudomucus” and “pseudothrombus”. Suctioning of saline with and without a tool in the working channel, with the bronchoscope fully flexed, suctioning of “pseudomucus”, and ability to suction different weights of “pseudothrombus” were performed. Suction ability as measured in seconds to complete evacuation of 60mL of various samples and task completion of suctioning different weights through an endotracheal tube (ETT) were measured. Statistical analysis with one-way analysis of variance (ANOVA) and Tukey’s Honestly Significant Difference (HSD) were completed.
Results: The Boston Scientific scope was significantly quicker in suctioning compared to each of the other scopes for each of the tests of suction (P < 0.01). The suction capability of the Glidescope over the Ambuscope was also superior (P < 0.01) for each test of suction. Both the Boston Scientific and Glidescope scopes were able to suction out a dry “pseudothrombus” up to 0.8grams and a wet “pseudothrombus” up to 7grams, which the Ambuscope was unable to do.
Conclusions: Therapeutic bronchoscopy in the ICU setting is an invaluable tool for providing rapid, life-saving treatment, usually in the setting of acute respiratory failure. SUFB’s vary in their suction capability for both clearance of saline, “pseudomucus”, and “pseudothrombus”, with the Boston Scientific bronchoscope being the highest performing. These bench model simulations should be validated in a clinical setting.
