[Flexible bronchoscopy in critical care units].

Since the introduction of flexible bronchoscopes (initially measuring 4.9 mm in diameter in the 1970s and posteriorly of other diameters), their use for diagnostic and therapeutic purposes in critical patients subjected to mechanical ventilation and in Intensive Care has become widespread. This number of the journal presents two studies that describe the experience of two Spanish Intensive Care Units with flexible bronchoscopy. Globally, both studies confirm that the technique is useful, with both diagnostic (microbiological studies of respiratory infection, identification of the origin of hemoptysis, etc.) and therapeutic indications (resolution of atelectasis secondary to the retention of secretions, difficult airway, etc.). Likewise, flexible bronchoscopy has been shown to be very effective as an aid to other procedures such as selective intubation or visual control during percutaneous tracheostomy. Considering these studies together with previous publications, it is notorious that although a large percentage of microbiological studies prove negative, flexible bronchoscopy makes a significant contribution to patient clinical management in almost one-half of all cases in which the technique is indicated. There are practically no strict contraindications to bronchoscopy in the Intensive Care Unit. Nevertheless, there are situations characterized by a marked increase in risk in which the advisability of bronchoscopy should be assessed on an individualized basis, according to the benefit expected from the procedure. In this context, serious coagulation disorders, very severe and refractory hypoxemia, intense hemodynamic instability despite the use of vasoactive drugs, uncontrolled arrhythmias or acute myocardial ischemia are