Indications for flexible bronchoscopy in elderly patients (≥ 75 years) with hypoxemic respiratory failure not eligible for intensive care: expert opinion based on a Delphi study

Background The indications for flexible bronchoscopy (FB) remain poorly defined in elderly patients (≥ 75 years) with hypoxemic respiratory failure (HRF) (O₂ ≥ 5 L/min) who are not eligible for intensive care. The lack of specific data highlights the need to develop evidence-based recommendations in this setting. Study design and methods A Delphi study was conducted among pulmonologists from the Groupe d’Endoscopie Thoracique et Interventionnel Francophone (GETIF). The first-round questionnaire included 18 statements. Consensus was defined as ≥ 70% of experts expressing agreement or disagreement. Non-consensual statements were reformulated based on expert comments and resubmitted for a second round. Results Thirty experts participated in the first round, of whom 26 completed the second round. Thirteen of 18 statements reached consensus. FB was considered ethically acceptable after systematic verification of advance directives. It was indicated in cases of bronchial congestion with radiologic atelectasis, foreign body aspiration, food aspiration, or after failed tracheal suction following inhaled vomitus. FB was not recommended in COPD exacerbation, acute heart failure, non-obstructive tumoral lesions, or exacerbation of idiopathic pulmonary fibrosis. Experts agreed that high-flow oxygen therapy and non-invasive ventilation could improve procedural tolerance. No consensus was reached for certain situations, particularly hemoptysis regardless of severity and tracheobronchial tumoral obstruction. Conclusion This study provides the first expert opinion on the indications for FB in elderly patients (≥ 75 years) with HRF who are not eligible for intensive care. The heterogeneity of responses for certain situations reflects the complexity of medical decision-making and underscores the need for further studies.