Toilet bronchoscopy in respiratory ICU: a randomized controlled clinical trial

Background
Toilet bronchoscopy is considered a possible therapeutic technique in the respiratory intensive care unit (RICU). Its role is to reverse pulmonary atelectasis by aspirating secretions that have been trapped in the airways and endotracheal tube. Its use also reduces ventilator-associated pneumonia incidence.


Objective
The purpose of this study was to evaluate the effectiveness of toilet bronchoscopy in treatment and rapid recovery of RICU patients with respiratory diseases.


Patients and methods
This cross–sectional randomized controlled clinical trial was conducted in Assiut University Hospital RICU from January 2022 to July 2024. Patients in the study had pulmonary atelectasis and a notable retention of airway secretions. Other less invasive methods were unable to reverse atelectasis and remove accumulated mucus.


Results
A total of 65 RICU patients underwent toilet bronchoscopy. Two groups of patients were randomly selected: group I (case group), group II (control group). The mean age of studied patients was 63 years, with a male predominance (77%). Toilet bronchoscopy significantly reduced ICU stay (7.83±2.64 days vs. 9.02±2.93 days; P 0.017). Also, improvement in lung compliance, resistance, oxygenation, and minute ventilation was achieved. In contrast, toilet bronchoscopy did not affect mortality or the total duration of hospitalization.


Conclusion
Toilet Bronchoscopy in RICU patients whenever available is recommended, as it improves lung compliance, resistance, oxygenation, and minute ventilation and reduces ICU stay.