ArticleIntensive care medicine experimental2025
Prediction and prevention of ventilation impairments during bronchoscopy.
Article in Intensive care medicine experimental, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Continuous monitoring of endotracheal tube obstructions using naturally occurring pressure and flow oscillations.Intensive care medicine experimental · 2026Article
- Standardized low-flow ventilation with PEEP maintenance during bronchoscopy in mechanically ventilated ICU patients: a pilot trial.Journal of intensive care · 2026Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBronchoscopy in ventilated patients narrows the endotracheal tube lumen and increases resistance, which can lead to hypoventilation and intrinsic PEEP build-up. These ventilation impairments depend on the geometry of the tube-bronchoscope combination, ventilator settings, and patient mechanics. Currently, no predictive method exists to quantify these impairments or guide compensatory strategies.
methodsWe measured pressure-flow relationships across multiple tube-bronchoscope configurations in a bench setup and derived a scaling law describing the nonlinear, flow-dependent resistance as a function of the effective tube diameter, defined as the diameter of a circular tube with the same open cross-sectional area as the remaining lumen. We then assessed the ventilatory consequences of bronchoscopy using an intensive care ventilator connected to an active lung simulator under both volume- and pressure-controlled modes.
resultsBronchoscope insertion sharply increases resistance, which scales with the inverse fifth power of the effective diameter. A simulation tool based on this scaling law accurately predicts the experimentally observed dynamic hyperinflation and intrinsic PEEP build-up in volume-controlled modes, as well as the reduced tidal volumes in pressure-controlled modes. Ventilation with automatic tube compensation during pressure control fully prevents both impairments.
conclusionsThe commonly cited recommendation of a ≥ 2 mm difference between endotracheal tube and bronchoscope diameters does not reliably prevent ventilation impairments during bronchoscopy. Our findings suggest that a quantitative framework, which accounts for ventilator settings, patient mechanics, and the effective tube diameter, can provide additional guidance for tube selection and help anticipate impairments. We demonstrate proof of principle that pressure-controlled ventilation with automatic tube compensation is a feasible strategy to mitigate bronchoscopy-induced ventilation impairments.
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