Prediction and prevention of ventilation impairments during bronchoscopy

The commonly cited recommendation of a ≥ 2 mm difference between endotracheal tube and bronchoscope diameters does not reliably prevent ventilation impairments during bronchoscopy. Our findings suggest that a quantitative framework, which accounts for ventilator settings, patient mechanics, and the effective tube diameter, can provide additional guidance for tube selection and help anticipate impairments. We demonstrate proof of principle that pressure-controlled ventilation with automatic tube compensation is a feasible strategy to mitigate bronchoscopy-induced ventilation impairments.