Single-use vs. reusable flexible bronchoscopes for airway management and in critical care: a narrative review

Introduction: Flexible bronchoscopes have become essential in the operating theatre environment and in critical care. This narrative review compared single-use and reusable flexible bronchoscopes with a focus on safety, efficacy, cost-effectiveness and environmental impact.

Methods: We searched MEDLINE, Embase and PubMed databases for studies related to flexible bronchoscopes for airway management or use in critical care. Human or animal studies of any design assessing single-use and reusable flexible bronchoscopes were included and qualitatively synthesised. We also searched manufacturer websites for relevant data.

Results: We included 52 studies and data from six manufacturer websites. There was mixed evidence for safety, and data on usability also showed significant heterogeneity, with different parameters, manufacturers and models examined. Neither single-use nor reusable flexible bronchoscopes appeared convincingly superior to the other for safety or usability. Cost analyses showed that the rate of use of flexible bronchoscopes per year, along with several other factors, affects cost-effectiveness for each institution, though the risk of cross-contamination is an advantage of single-use devices. However, sufficient evidence on the rate of bronchoscopy-induced infection in the operating theatre and critical care environment is lacking. Due to the risk of cross-contamination, single-use flexible bronchoscopes must be sterilised or incinerated after use, and completely recyclable single-use models are not currently available.

Conclusions: Further research is required on safety, usability and life cycle assessment in the operating theatre and critical care environment, as well as on the rate of bronchoscopy-induced infection. Future comparative studies, including new manufacturers and designs, may lend further insights.