Fiberoptic Bronchoscopy in Neonatal and Pediatric Intensive Care Units: A 5-Year Experience

Abstract

Objectives: To determine the value and safety of fiberoptic bronchoscopy in neonatal and pediatric intensive care units (NICUs, PICUs). Subject and Methods: A total of 53 fiberoptic bronchoscopy procedures on 47 patients were reviewed. Bronchoalveolar lavage (BAL) was performed in 23 patients. Results: The primary diseases were pneumonia (n = 16), foreign body aspiration (n = 14), congenital airway abnormality (n = 12), trauma and/or following operations (n = 4) and Guillain-Barré syndrome (n = 1). The major bronchoscopic findings included inflammation in 26 patients, foreign body in 14, congenital airway abnormality in 12 and blood clotting in 3. Microbiology on BAL fluid was positive in 19 of 23 patients. In 23 patients with atelectasis, full and partial re-expansion was obtained in 14 and 6 patients, respectively, at 24 h after the procedures. The clinical features of 9 patients with sputum retention or blood clotting improved significantly after BAL. Positive or negative microbiologic BAL fluid results changed treatment in 11 patients, leading to marked clinical improvement in 9 patients. Moreover, 13 patients were extubated within 24 h of bronchoscopy. Conclusion: These data show that fiberoptic bronchoscopy is safe and effective in the diagnosis and therapy of pulmonary disorders in NICUs and PICUs.

Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: A systematic review

“…De Blic et al [4] reported that in children with CHD, FFB findings of external compression of the airways by cardiovascular anomalies prompted earlier cardiac surgery in 50% (5/10) [4] . Twenty-one studies reported an overall diagnostic yield of 82% using FFB (range 45.2%-100%; 3791/4 622) [3][4][5][14][15][16][17][18][20][21][22][23][24][25][26][27][28][29][30][31][32][33] . [27] , 2011 [20,24,31] .…”

“…[27] , 2011 [20,24,31] . Lower airway findings included airway stenosis, compression, malacia, mucus plugs, thrombus, and malpositioned endotracheal tube [3,14,15,17,18,20,21,23,24,31,32] . The diagnostic yield of FFB varied amongst different patient populations.…”

“…Even though the first published report on the utility of FFB in children was in 1978, rigid bronchoscopy by surgeons remained standard of practice for many years due to instrument size limitations [1,2] . With the advent of smaller-sized bronchoscopes, FFB use has increased in pediatric and neonatal patients [3][4][5][6] . In 1987, the first published FFB guideline for adults provided recommendations for the use of bronchoscopy for diagnosis and management of a broad spectrum of inflammatory, infectious, and malignant diseases [7] .…”

“…Our specific questions were: (1) what is the diagnostic yield of FFB; (2) what is the therapeutic efficacy of FFB; and (3) what is the rate of adverse events secondary to FFB?…”

Full Airway Drainage by Fiber Bronchoscopy Through Artificial Airway in the Treatment of Occult Traumatic Atelectasis

“…The therapeutic principle for this condition is timely full drainage of sputum and blood at early stage. Although use of an artificial airway and fiber bronchoscopy for the treatment of severe traumatic atelectasis with dyspnea or massive hemoptysis is now accepted [2,3], there still remain several problems as follows: first, for young patients with atypical manifestations and sufficient compensation of pulmonary function, it is difficult to make the decision to create an artificial airway to drain sputum and blood. But the pathological injury might be aggravated gradually without timely drainage; second, manipulation of the fiber bronchoscope through the nasal cavity may lead to patients' resistance and breath-holding, which can make it difficult for the patients to tolerate repeated treatment within a short period of time; on the other hand, breath-holding can increase the airway pressure, thereby exacerbating the original airway injury, or even b u r s t , w h i c h m a y c a u s e a p n e u m o t h o r a x o r pneumomediastinum.…”