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BMJ Case Rep. 2013 Aug 7;2013. pii: bcr2013200177. doi: 10.1136/bcr-2013-200177.

Recruitment bronchoscopy by trans-glottic approach successfully treated lung collapse in an intubated mechanically ventilated patient.

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Pulmonary and Critical Care Department, Advanced Thoracic Research Center, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.


Pulmonary lower lobe atelectasis/collapse is a common problem in patients undergoing mechanical ventilation. It also occurs in non-intubated patients with traumatic brain or spinal cord injuries, morbid obesities and chest wall disorders. Conventional manoeuvres such as chest physiotherapy, bronchodilators and positive-end expiratory pressure (PEEP) administration are frequently used in its management with variable success rates. However, despite the reported success of bronchoscopic recruitment manoeuvres, selective intrabronchial air insufflation during fiberoptic bronchoscopy to re-expand collapsed lungs is an underutilised practice. Here, we report an example of successful selective intrabronchial air insufflation in an intubated patient with bilateral lower lobe collapses after surgery for an incarcerated hernia. To our knowledge, this is the first successful report of recruitment manoeuvre by trans-glottic bronchoscopy in an intubated, mechanically ventilated patient.

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