Complications and risk factors in pediatric bronchoscopy in a tertiary pediatric respiratory center

Self Cite

Introduction Foreign body (FB) aspiration is a frequent and preventable source of morbidity and mortality, especially in children under 4 years of age. Few comprehensive studies exist on presentation and outcome of apple aspirations in children. Methods In a retrospective analysis of bronchoscopy records of a tertiary medical care center from January 2007 to August 2019, we identified pediatric cases of suspected apple aspirations. Results A total of 11 suspected apple aspirations were identified (observation time 12.7 years, n = 5858 bronchoscopies, n = 226 interventions due to suspected FB aspirations in total). The mean age of patients was 24 months (standard error mean, 7 months; range, 8‐83 months), and 6 out of 11 cases (55%) were male. Bronchoscopy confirmed apple aspiration in n = 6/11 cases (55%). In n = 2/11 cases (18%), a bite of the apple was located in the esophagus causing significant tracheal narrowing, and in n = 3/11 cases (27%), no FB was found. In all cases of airway FB identification, extraction was successful. Hypersalivation was associated with esophageal FB location, whereas persistent cough, stridor, or dyspnea were associated with airway FB location. Outcomes ranged from complete reconstitution 1 day after bronchoscopy in most cases to hypoxemia with severe brain damage in one patient. Discussion This analysis shows that apple aspirations are not entirely uncommon in children and may lead to disastrous complications. Typical signs of airway location are persistent cough, stridor or dyspnea, whereas hypersalivation may point toward an esophageal location. In each case of suspected apple aspiration, timely bronchoscopy with possible FB extraction should be performed by an experienced team.

supporting

confidence: 52%

Section: Bronchoscopymentioning

confidence: 99%

An apple a day won't keep the doctor away: presentation, treatment, and outcome in pediatric apple aspirations

Scharff

Schwerk

Baumann

et al. 2020

Self Cite

“…Flexible bronchoscopy (FB), now a standard tool in paediatric pulmonology tertiary practice, is commonly used to evaluate children with persistent or recurrent respiratory symptoms. 1 During FB, macroscopic airway visualization of bronchitis is commonly described in clinical practice. However, to date, there is no systematically assessed or quantified scores of FB in children.…”

Section: Discussionmentioning

confidence: 99%

Towards developing a valid scoring tool for bronchitis during flexible bronchoscopy

Thomas

McElrea

et al. 2018

Background A valid bronchoscopic scoring tool for bronchitis would be useful for clinical and research purposes as currently there are none in children. From 100 digitally recorded flexible bronchoscopies (FB), we related the various macroscopic features to airway neutrophil % to develop a FB‐derived bronchitis score (BScoreexp). We aimed to develop a FB‐derived bronchitis tool. Methods FB recordings for six visualised features: secretions (amount and color) and mucosal appearance (erythema, pallor, ridging, oedema) based on pre‐determined criteria on a pictorial chart were assessed by two physicians independently, blinded to the clinical history. These features were used to obtain various models of BScoreexp that were plotted against bronchoalveolar lavage (BAL) neutrophil % using a receiver operating characteristic (ROC) curve. Inter‐ and intra‐rater agreement (weighted‐kappa, K) were assessed from 30 FBs. Results Using BAL neutrophilia of 20% to define inflammation, the highest area under ROC (aROC) of 0.71, 95%CI 0.61‐0.82 was obtained by the giving three times weightage to secretion amount and color and adding it to erythema and oedema. Inter‐rater K values for secretion amount (K = 0.87, 95%CI 0.73‐1.0) and color (K = 0.86, 95%CI 0.69‐1.0) were excellent. Respective intra‐rater K were 0.95 (0.87‐1.0) and 0.68 (0.47‐0.89). Other inter‐rater K ranged from 0.4 (erythema) to 0.64 (pallor). Conclusion A repeatable FB‐defined bronchitis scoring tool can be derived. However, a prospective study needs to be performed with larger numbers to further evaluate and validate these results.

“…Relatively few recent studies have quantified risk of flexible bronchoscopy in children. A retrospective analysis of 670 bronchoscopies in 522 children over a 4‐year period was reported by Carlens et al in Hannover, Germany. For the analysis, procedures done in intensive care or after lung transplant were excluded.…”

Section: Diagnostic Testing: Imaging and Endoscopymentioning

confidence: 99%

Pediatric Pulmonology Year in Review 2018: Rare lung disease, neuromuscular disease, and diagnostic testing

Gower

Birnkrant

Black

et al. 2019

Pediatric Pulmonology publishes original research, case reports, and review articles on topics related to a wide range of children's respiratory disorders. In this article, we highlight the past year's publications in the topic areas of rare lung diseases, respiratory complications of neuromuscular disorders, and diagnostic testing, as well as selected literature in these areas from other journals.