What pre-procedural assessments are necessary for patients undergoing bronchoscopy?

Before bronchoscopy, patients should undergo a thorough clinical assessment including a detailed history and physical examination to evaluate respiratory and cardiovascular status. Pre-procedural assessments should include:

• Review of respiratory function, including spirometry if available, to assess baseline lung function and identify any obstructive or restrictive patterns. ¹
• Chest imaging such as chest X-ray or CT scan to identify any abnormalities that may affect the procedure or indicate alternative diagnoses. ^1,3
• Assessment of coagulation status and platelet count to minimise bleeding risk during biopsy or sampling. (Implied standard practice, not explicitly in provided text but consistent with UK guidelines)
• Evaluation of cardiac status, including ECG and serum natriuretic peptides if there is a history or signs of cardiac disease or pulmonary hypertension, to reduce peri-procedural risk. ¹
• Consideration of renal function before administration of contrast medium if contrast-enhanced imaging is planned. ³
• Ensuring adequate oxygenation and ventilation status, and assessing for any contraindications such as severe hypoxia or unstable respiratory failure. (General clinical practice consistent with respiratory guidelines)

Additional investigations such as sputum culture may be performed if infection is suspected, and echocardiography if cardiac disease is suspected. ¹ For patients with suspected lung cancer, contrast-enhanced CT of the chest, liver, adrenals, and lower neck is recommended before biopsy procedures including bronchoscopy. ³