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

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: Flexible bronchoscopy performed by trained emergency physicians appears safe and feasible.