Work

Prospective evaluation of flexible bronchoscopy in the emergency department: Indications, findings, and complications. A cohort study

Year: 2026

Type: article

Abstract: Flexible bronchoscopy (FBS) is a widely used diagnostic and therapeutic tool in intensive care and pulmonary medicine. However, its role in the emergency department (ED) is less well established, especially in emergency physicians' hands. The aim of this study was to describe the indications, findings, outcomes, and complications of FBS performed by emergency physicians in the ED following structured training, with a specific focus on its feasibility and safety. This was a prospective single-center cohort study at Careggi University Hospital (Florence, Italy), including all patients undergoing FBS in the ED between January 1, 2023, and September 1, 2025. Demographic data, clinical indications, outcomes, and complications were prospectively collected and analyzed. We prospectively enrolled 431 patients (median age 69 years, 43.4% female), the majority of whom were non-intubated (86.8%). The main indications were pneumonia or respiratory infection (40.4%), hemoptysis (19.3%), and bronchial toilet for secretion clearance (18.3%). Common bronchoscopic findings included purulent secretions (42.2%), mucus plugs (9.9%), and airway bleeding (12.3%). Bronchoalveolar lavage was performed in 46.6% of cases, and bronchial toilet in 18.3%. A clinical improvement was observed in 24.4% of patients, while 70.8% showed no immediate change. Complications were minor and self-limited, with no major adverse events or procedure-related deaths recorded. Flexible bronchoscopy performed by trained emergency physicians appears safe and feasible. • First prospective study demonstrating that flexible bronchoscopy is a feasible frontline tool in the Emergency Department. • Demonstrates that flexible bronchoscopy can be safely integrated into emergency care pathways, expanding the procedural capabilities of emergency medicine as a specialty. • Flexible bronchoscopy was feasible and safe when performed by emergency physicians after a structured training program, with a low complication rate. • The study introduces a structured and hierarchical training model enabling emergency physicians to achieve procedural competence, demonstrating an exportable and scalable educational pathway for international emergency medicine programs.

Source: The American Journal of Emergency Medicine

DOI: 10.1016/j.ajem.2026.01.036

Authors: Lorenzo Pelagatti, Simone Vanni, Lorenzo Corbetta, Peiman Nazerian

Institutions: Azienda Ospedaliero-Universitaria Careggi, University of Florence

Language: English

Topic: Tracheal and airway disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,980