Airway & Bronchoscopy

Rigid Bronchoscopy: Indications, Technique, and Troubleshooting

Aligns modern malignant and benign airway obstruction management with stepwise rigid bronchoscopy technique, including ventilation strategies, debulking workflow, stenting pearls, and crisis algorithms.

Rigid bronchoscopy • Bleeding control • Airway stentsReading time · 32mWord count · 3,149

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Exam mapping & scope

Exam Mapping & Scope This chapter aligns with the AABIP IP Board Procedural Knowledge → Rigid Bronchoscopy/Foreign Body Retrieval domain. It consolidates contemporary indications and contraindications, anesthesia and ventilation strategies, step-by-step technique (including tumor debulking and foreign body removal), troubleshooting, complications, outcomes, and high-yield pearls for exam success and clinical practice.

Focus this round

Debulking sequence
Foreign body extraction
Complication mitigation

Orientation

Interactive chapter

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High-yield pearls

RB is the instrument of choice for acute central airway compromise (malignant or benign), massive hemoptysis, and complex foreign body (FB) extraction—owing to superior ventilation control, suction, ability to tamponade bleeding, and the capacity to pass large instruments.
Absolute contraindication: cervical spine instability. Relative contraindications: prior cervical fusion, hemodynamic instability, severe hypoxemia, coagulopathy/thrombocytopenia, and operator inexperience.
Anesthesia: RB is performed under general anesthesia. TIVA is preferred over inhalational agents because RB is an open system.
Ventilation: Spontaneous-assisted allows PEEP and closed-system monitoring; jet ventilation enables rapid FiO₂ reduction before thermal therapies but lacks airway pressure monitoring and carries barotrauma risk.
Technical success of therapeutic bronchoscopy for malignant central airway obstruction (CAO) is high (~93%). Dyspnea improvement is greatest with higher baseline symptom burden; lobar-only disease benefits less.
Predictors of success: endobronchial disease and stent placement increase success; ASA >3, renal failure, left main disease, and TEF decrease success.
Complications overall ~3.9%; procedure-related mortality ~0.5%. Risks rise with urgent/emergent cases, ASA >3, redo procedures, and the use of moderate sedation.
Thirty-day mortality reflects disease burden; associated with ASA >3, ECOG >1, intrinsic or mixed obstruction, and stent placement (especially Y-stent).

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Study notes

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Rigid Bronchoscopy: Indications, Technique, and Troubleshooting

Exam mapping & scope

Focus this round

Orientation

Learning Objectives

High-Yield One-Pager

Contraindications:

Pre-procedure Evaluation

Equipment & Setup

Rigid intubation (core steps):

Tumor debulking (intrinsic or mixed):

Foreign body extraction:

Troubleshooting & Intra-procedure Management

Ventilation selection:

Post-procedure Care & Follow-up

Complications: Prevention, Recognition, Management

Special Populations / Situations

Evidence & Outcomes

Malignant Central Airway Obstruction (MCAO) - Endoscopic Management

Parallel bullet algorithm (quick reference):

Massive Hemoptysis (Stabilization & Control)

Table 1. Contraindications to Rigid Bronchoscopy

Table 2. Rigid Bronchoscope Quick Specs

Table 3. Anesthesia & Ventilation Options in RB

Table 4. Debulking Sequence for Intrinsic Endobronchial Tumor

Imaging & Figure Callouts (Placeholders)

Cases & Applied Learning

Question Bank (MCQs)

Controversies, Variability, and Evolving Evidence

Take-Home Checklist

References