Development and validation of a bronchoscopically defined bronchitis scoring tool in children

Eg, Kah Peng; Thomas, Rahul; McElrea, Margaret S; Marchant, Julie M.; Chang, Anne B.

doi:10.1002/ppul.24924

Cited by 6 publications

(7 citation statements)

References 34 publications

(87 reference statements)

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“…The macroscopic features of airway secretions in terms of amount and color may suggest airway inflammation and correlate with BAL neutrophil count. 29 Ventilator-induced lung injury and lower respiratory tract infections are the main causes of airway inflammation in ICUs, and several studies conducted in ICU reported increased secretions in line with our study. 18,19,[30][31][32] Increased secretions were more common in children aged more than 5 months in the current study, which may be related to the increased number of patients who underwent FB for persistent pneumonia and atelectasis in this age group.…”

Section: Discussionsupporting

confidence: 91%

“…The second most common finding in FB was the presence of excessive secretions in the airways, which were present in almost half of our patients. The macroscopic features of airway secretions in terms of amount and color may suggest airway inflammation and correlate with BAL neutrophil count 29 . Ventilator‐induced lung injury and lower respiratory tract infections are the main causes of airway inflammation in ICUs, and several studies conducted in ICU reported increased secretions in line with our study 18,19,30–32 .…”

Section: Discussionsupporting

confidence: 86%

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Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study

Atağ

Ünal

Yazan

et al. 2021

Pediatric Pulmonology

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Introduction: Flexible bronchoscopy (FB) is frequently used for assessment and treatment of patients with respiratory diseases. Our aim was to investigate the contribution of FB to diagnosis and therapy in children admitted to the intensive care units (ICU) and to evaluate the safety of FB in this vulnerable population.Methods: Children less than 18 years of age who underwent FB in the five neonatal and pediatric ICUs in Istanbul between July 1st, 2015 and July 1st, 2020 were included to the study. Demographic and clinical data including bronchoscopy indications, findings, complications, and the contribution of bronchoscopy to the management were retrospectively reviewed.Results: One hundred and ninety-six patients were included to the study. The median age was 5 months (range 0.3-205 months). The most common indication of FB was extubation failure (38.3%), followed by suspected airway disease.Bronchoscopic assessments revealed at least one abnormality in 90.8% patients. The most common findings were airway malacia and the presence of excessive airway secretions (47.4% and 35.7%, respectively). Positive contribution of FB was identified in 87.2% of the patients. FB had greater than 1 positive contribution in 138 patients and 80.6% of the patients received a new diagnosis. Medical therapy was modified after the procedure in 39.8% and surgical interventions were pursued in 40% of the patients. Therapeutic lavage was achieved in 18.9%. There were no major complications. Conclusion:Flexible bronchoscopy is a valuable diagnostic and therapeutic tool in neonatal and pediatric ICUs and is not associated with major complications.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 86%

Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study

Atağ

Ünal

Yazan

et al. 2021

Pediatric Pulmonology

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“…It was not until 2018 that researchers, such as Thomas, developed a bronchial inflammation scoring tool [11]. In 2020, a team led by Thompson validated six visual characteristics -secretions (number and colour) and mucosal appearance (erythema, pallor, elevation and oedema) -in a prospective study and concluded that secretion volume and colour, and mucosal oedema and erythema were significantly associated with BAL neutrophils [23]. Lung inflammation can be reflected by the endobronchial lining and secretions.…”

Section: Discussionmentioning

confidence: 99%

Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

Sang

et al. 2023

Ital J Pediatr

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Background There is still a lack of effective scoring criteria for assessing the severity of pulmonary infection associated with changes in the endobronchial lining of the bronchus in children. This study aimed to ascertain the timing and value of endoscopic scoring of fibreoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in children with severe pneumonia. Method The clinical data of 229 children with severe pneumonia treated with BAL in the Pediatric Intensive Care Unit of the First Affiliated Hospital of Xinxiang Medical University between November 2018 and December 2021 were collected. According to the severity of the disease, patients were divided into an invasive ventilation group and a non-invasive ventilation group, as well as an early BAL group (receiving BAL within 1 day of admission) and a late BAL group (receiving BAL 2 days after admission). A Student’s t-test, Chi-square test, receiver operating characteristic (ROC) curve and survival curve were used to analyse the bronchitis score, aetiology of BAL fluid and survival data. Results The scores of endoscopic mucosal oedema, erythema and pallor and the total score in the invasive ventilation group were higher than those in the non-invasive ventilation group (P < 0.05), and they were consistent with the Sequential Organ Failure Assessment (SOFA) scores. The secretion colour score was lower in the early BAL group than in the late BAL group (P < 0.05). On the bronchitis scores, which were evaluated using a ROC curve, the difference in the mucosal erythema, pallor, oedema and total score of the invasive and non-invasive groups was statistically significant (P < 0.05), which was consistent with the area under the ROC of the SOFA scores. Acute Physiology and Chronic Health Assessment II and SOFA scores after FOB were lower than those before treatment (P < 0.05). In terms of ICU hospitalisation days and total hospitalisation days, the time of the early FOB patients was shorter than that of the late FOB patients (P < 0.05). A total of 22 patients (9.61%) died. The Kaplan–Meier analysis and log-rank test showed that the survival rate of the non-invasive ventilation group was higher than that of the invasive ventilation group (P < 0.05). Conclusion This study found that FOB combined with BAL is an important method for the diagnosis and treatment of severe pneumonia. Early BAL can reduce hospitalisation and ICU time; however, it cannot improve the survival rate. The endoscopic score has a certain role to play in assessing the severity of pulmonary inflammation, but studies with a large sample are still needed to confirm this.

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“…Although visual bronchoscopy scores have been validated (25), general visual assessment and bronchoalveolar lavage with cell count and differential are the gold standards for assessing outcomes. However, inflammatory profiles on bronchoalveolar lavage are not specific to alveolar inflammation from dysphagia and aspiration (26).…”

Section: Diagnostics Approaches To Opdmentioning

confidence: 99%

Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia

Krasaelap,

Duncan,

Sabe

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Aerodigestive disorders encompass various pathological conditions affecting the lungs, upper airway, and gastrointestinal tract in children. While advanced care has primarily occurred in specialty centers, many children first present to general pediatric gastroenterologists with aerodigestive symptoms necessitating awareness of these conditions. At the 2021 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the aerodigestive Special Interest Group held a full-day symposium entitled, Pediatric Aerodigestive Medicine: Advancing Collaborative Care of Children with Aerodigestive Disorders. The symposium aimed to underline the significance of a multidisciplinary approach to achieve better outcomes for these complex patients. Methods: The symposium brought together leading experts to highlight the growing aerodigestive field, promote new scientific and therapeutic strategies, share the structure and benefits of a multidisciplinary approach in diagnosing common and rare aerodigestive disorders, and foster multidisciplinary discussion of complex cases while highlighting the range of therapeutic and diagnostic options. In this article, we showcase the diagnostic and therapeutic approach to oropharyngeal dysphagia, one of the most common aerodigestive conditions, emphasizing the role of a collaborative model. Conclusions: The aerodigestive field has made significant progress and continues to grow due to a unique multidisciplinary, collaborative model of care for these conditions. Despite diagnostic and therapeutic challenges, the multidisciplinary approach has enabled and greatly improved efficient, high-quality, and evidence-based care for patients, including those with oropharyngeal dysphagia.

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Development and validation of a bronchoscopically defined bronchitis scoring tool in children

Cited by 6 publications

References 34 publications

Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study

Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study

Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia

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