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 Obtain informed consent (in ICU this is usually from the health care proxy).

 NPO for at least 4–6 hours prior to the procedure if possible in non‐emergent or non‐intubated patients; tube feeds should be held before the procedure.

 Perform time out.

 Set up: done in a monitored setting with ECG recording, BP monitoring, O2 saturation monitoring, bronchoscope, accessories for the bronchoscope (e.g. brush, forceps, balloon), bronchoscopic adaptor (ventilator and bronchoscope can both be use at the same time), specimen collecting system, saline (some should be ice cold), alcohol, slides, epinephrine, lidocaine (solution and gel), oxygen, ETT, oral piece, gauzes, port syringes, suctioning system, IV fluid, sedative, analgesics, lubrication, vasopressor agents, and resuscitation medications (e.g. naloxone) available if needed.

 Protective wear available.

 Personnel: bronchoscopist, bronchoscopist assistant (to help with use of forceps, brush, ETT stabilization, etc.), critical care nurse, and respiratory therapist.

 Lab work: generally not needed but PTT and INR in cases of hemoptysis.

 In non‐intubated patients, the nares/airways should be anesthetized with aerosolized lidocaine and lidocaine gel.

 In intubated patients, the ETT should be at least 7.5–8 mm in diameter for the typical bronchoscope to pass. ETT change may be necessary.

 In intubated patients, the airway can be sprayed with lidocaine or the lidocaine can be nebulized before the start of the procedure. About 400–600 mg can be safely used for the entire procedure.

 Sedatives should be given for moderate sedation in non‐intubated patients. Typical medications are midazolam (noted to decrease salivation during bronchoscopy) or propofol used with fentanyl (to decrease coughing). For intubated and sedated patients, an increase in the baseline sedative(s) is required.

 Generally patients should be placed on 100% oxygen. In the ICU, most patients requiring bronchoscopic procedures are intubated.