Role of interventional pulmonology in intensive care units: A scoping review

Table 1 Tools in hemoptysis

Feature	Flexible bronchoscopy	Rigid bronchoscopy
Invasiveness	Less invasive; performed via nose or mouth	More invasive; requires general anesthesia and operating room
Airway control	Limited	Excellent
Reach	Greater; can access smaller, more peripheral airways	Limited; may not reach distal airways as effectively
Working channel	Narrower	Wider
Suctioning capacity	Limited	Greater
Instrument size	Limited	Larger instruments can be used
Visualization	May be limited in larger airways	Better visualization due to larger instruments
Tamponade	Possible, but less effective	Easier to achieve direct compression
Versatility	Allows for biopsies, lavages, and some therapeutic interventions	Primarily used for airway control and managing massive hemoptysis
Sedation	Often done under conscious sedation	Requires general anesthesia
Recovery time	Faster	Longer due to general anesthesia
Complications	Lower risk	Higher risk, although rare
Patient tolerance	Generally, more comfortable	Less comfortable due to larger scope

This table provides a general comparison. The best choice of bronchoscopy depends on the specific clinical situation and the expertise of the bronchoscopist.

Table 2 Tools used in aspirated foreign bodies

Tool	Type of FB	Technique	Advantages	Disadvantages
Forceps	Inorganic	Advanced through the working channel of the bronchoscope, external grip-handle can be used to open and close the forceps	Common, available, and easy to use. Able to grip thin, small, or flat shaped objects	Risk of fragmentation and distal displacement with organic FB
Snares	Organic and inorganic	Looping or lassoing technique, passed through the bronchoscope to encircle the FB under direct visualization	Useful for larger or irregularly shaped objects such as dental prosthesis, allows for secure capture	Not as readily available. Difficult to use on small or slippery FB
Baskets	Organic and inorganic	Expands to ensnare and retrieve the FB. After its deployed out of the sheath and past the foreign body, the basket is pulled back in a rotation axis to snare the foreign body	Good for retrieving multiple small objects, or irregularly shaped FB	Limited to soft or pliable FB, less effective for large or rigid FB. Friable objects may also fragment and fall out of the basket, in which case a fishnet basket may be more useful
Cryo-probe	Organic, or FB with high moisture/water content	Freezes the FB to the probe, allowing for extraction. The probe along with the bronchoscope is then retrieved through the endotracheal tube	Excellent for organic material, non-fragmenting. Useful for extraction of granulation tissue formed around the FB. Tracheal and bronchial cartilaginous tissue are resistant to cryotherapy	Requires precision, risk of damaging nearby tissue. Care must be taken so that the adjoining mucosa does not form part of the crystal

FB: Foreign body.

Table 3 Tools in central airway obstruction

Tool	Technique	Indication	Advantages	Disadvantages
Electro-cautery	Electrical current applied via a probe to burn or coagulate tissue, electrocautery knives can also be used for tissue resection prior to dilation	Removal of tumors, hemostasis, tissue resection in subglottic stenosis	Precise control, minimal bleeding, and immediate effect. Useful in removal of pedunculated masses (electrocautery snare)	Risk of thermal injury to surrounding tissue, requires low fractional inspired oxygen
Balloon dilation	Balloon catheter inserted and inflated to dilate stenosed airways	Tracheal/bronchial stenosis	Minimally invasive. Can be utilized prior to stent placed to achieve long-term airway patency	Risk of tearing or perforation of the airway
Laser therapy	Used to cut or vaporize obstructive tissue in the airway (Nd:YAG laser most commonly used)	Obstruction from tumors or benign growths	High precision, effective in debulking obstructive lesions	Risk of thermal injury. Risk of damaging surrounding tissue. Costly, not widely accessible
Cryo-probe	Freezing tissue with liquid nitrogen or other cryogenic substance, allowing tissue adhesion and destruction	Treatment and debulking of benign or malignant tumors. Foreign body removal	Minimizes bleeding. Effective for organic tissue	Multiple treatments may be required to debulk large tumors
Argon plasma coagulation	Non-contact thermal coagulation using ionized argon gas	Useful in control of bleeding, useful in granulation tissue formed at the site of surgical anastomosis	Effective for superficial bleeding lesions, less risk of perforation	Does not result in tumor vaporization, and not ideal for debulking large masses

Table 4 Airway stents

	Metallic endobronchial stent		Silicone endobronchial
	Covered	Uncovered
Indications	Malignant tracheobronchial obstruction. Prevention of tumor ingrowth. Tracheoesophageal fistulas	Limited uses due to significant potential complications. Anastomotic dehiscence following lung transplantation. Can be used for benign conditions, but only short term, however not first line	Benign airway stenosis. Post-lung transplant airway complications. Malignant airway obstruction (palliative)
Advantages	Prevents tumor ingrowth. Reduces risk of fistula formation. Can be placed with flexible bronchoscopy	Lower risk of migration than covered stents. Can be placed with flexible bronchoscopy. Preserve muco-ciliary function	Easily removable. Less granulation tissue formation compared to metallic stents. Can be used in benign disease. Can be customized during the procedure (i.e., cut to adjust length). Varying shapes, such as cylindrical, or Y-shaped
Disadvantages	Higher migration risk. May obstruct smaller airways or bronchi	Tumor or granulation tissue can grow through the stent, leading to restenosis. Black box warning in benign disease, due to tissue hyperplasia, embodiment in tissue, and consequent occlusion. Difficult to remove	Higher migration risk compared to metallic stents. Requires rigid bronchoscopy for placement