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Although activated charcoal is an effective treatment for most toxic ingestions, aspiration of activated charcoal can be fatal. Here, we report that in 5 charcoal aspiration cases, bronchoscopy with suction and lavage was an effective way to remove charcoal from the lungs. Patients showed high APACHE II scores (range: 10-29), and either low PO2 levels, or low CO2 retention. After bronchoscopic removal of the aspirated charcoal, symptoms of hypoxia, CO2 retention, localized wheezing, and pneumonic infiltration as determined by chest radiography, improved in most patients. We report 5 cases of successful treatment of charcoal aspiration with bronchoscopic toilet.