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Review
. 2021 Aug;13(8):5331-5342.
doi: 10.21037/jtd-20-3595.

Equipment and procedural setup for interventional pulmonology procedures in the intensive care unit

Amrik S Ray  1 , Van K Holden  2 , Ashutosh Sachdeva  2 , Faria Nasim  2
Affiliations
Review

Equipment and procedural setup for interventional pulmonology procedures in the intensive care unit

Amrik S Ray et al. J Thorac Dis. 2021 Aug.

Abstract

Procedural setup is an important aspect of any procedure. Interventional pulmonologists provide a procedural practice and have additional expertise in performing high-risk procedures needed in the critically ill patients in intensive care. Taking the time to plan the procedure setup in advance and having all necessary equipment readily available at the patient's bedside is imperative for procedural services. This is especially essential to ensure patient safety, minimize risk of complications, and improve success for specialized procedures performed by interventional pulmonary in the intensive care unit. In this review we describe the equipment and procedural setup ideal for both pleural and airway procedures. These include flexible diagnostic and therapeutic bronchoscopy, ultrasound guided thoracentesis, chest tube insertion, difficult airway management, and bedside percutaneous dilatation tracheostomy. We provide a guide checklist for these procedures emphasizing the practical aspects of each procedure from selecting the appropriate size endotracheal tube to operator positioning to ensure efficiency and best access. The components of procedural setup are discussed in relation to patient factors that include patient positioning and anesthesia, personnel in the procedure team and the equipment itself. We further briefly describe the additional equipment needed for specialized techniques in therapeutic bronchoscopy used by interventional pulmonologists.

Keywords: Procedural setup; bedside intensive care unit procedures (bedside ICU procedures); bronchoscopy equipment; interventional pulmonary.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-3595). The series “Interventional Pulmonology in the Intensive Care Unit Environment” was commissioned by the editorial office without any funding sponsorship. AS served as the unpaid Guest Editor of the series. All authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Bedside bronchoscopy setup in an intensive care unit with the operator at the side of the bed. Notice the inverted carina in the bronchoscopic image with the left mainstem visualized on the right side of the monitor.
Figure 2
Figure 2
An example of a bronchoscope set up with a ventilator connected to an LMA via a swivel adaptor. Note the bite block present around the LMA to prevent scope damage. LMA, laryngeal mask airway.
Figure 3
Figure 3
Arndt Bronchial Blocker. The appropriate swivel adaptor is in the center with the blocker itself wrapped around the edge of the packaging. The device in the center left of the screen is an adaptor for jet ventilation.
Figure 4
Figure 4
Point of Care SonoSite Ultrasound on top. Two probes visible below, with a high frequency linear transducer on the left and a small footprint phased array transducer on the right.
Figure 5
Figure 5
Bedside setup for pleural ultrasound prior to thoracentesis in an intensive care unit.
Figure 6
Figure 6
Tracheal ultrasound showing the tracheal air show in the middle. Note the absence of any large vessels or significant thyroid tissue.
Figure 7
Figure 7
Percutaneous dilatational tracheostomy being performed with bronchoscopic guidance in an intensive care unit.
See this image and copyright information in PMC

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