Flexible bronchoscopy in pediatric intensive care

Davidson, Mark; Coutts, J. R. T.; Bell, Graham

doi:10.1002/ppul.20910

Cited by 28 publications

(47 citation statements)

References 18 publications

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“…[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.…”

Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

“…Almost all FFB were performed at the bedside, with the exception of routine evaluation for esophageal atresia, where the procedure took place in the operating room [14] . The patient populations undergoing FFB included patients evaluated for a spectrum of anatomic airway or intrinsic pulmonary abnormalities, including patients with congenital heart disease (CHD) (7/27; 26% studies) and patients on extracorporeal life support (ECLS) (4/27; 15% studies) [4,[15][16][17][18][19][20][21][22][23] . FFB was performed multiple times on patients in 55% of the studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…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] .…”

Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

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

Field-Ridley

Sethi

Murthi

et al. 2015

WJCCM

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AIM:To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to flexible fiberoptic bronchoscopy (FFB) in critically ill children. METHODS:We searched PubMed, SCOPUS, OVID, and EMBASE databases through July 2014 for English language publications studying FFB performed in the intensive care unit in children < 18 years old. We identified 666 studies, of which 89 full-text studies were screened for further review. Two reviewers independently determined that 27 of these studies met inclusion criteria and extracted data. We examined the diagnostic yield of FFB among upper and lower airway evaluations, as well as the utility of bronchoalveolar lavage (BAL). RESULTS:We found that FFB led to a change in medical management in 28.9% (range 21.9%-69.2%) of critically ill children. The diagnostic yield of FFB was 82% (range 45.2%-100%). Infectious organisms were identified in 25.7% (17.6%-75%) of BALs performed, resulting in a change of antimicrobial management in 19.1% (range: 12.2%-75%). FFB successfully reexpanded atelectasis or removed mucus plugs in 60.3% (range: 23.8%-100%) of patients with atelectasis. Adverse events were reported in 12.9% (range: 0.5%-71.4%) of patients. The most common adverse effects of FFB were transient hypotension, hypoxia and/ or bradycardia that resolved with minimal intervention, such as oxygen supplementation or removal of the bronchoscope. Serious adverse events were uncommon; 2.1% of adverse events required intervention such as bag-mask ventilation or intubation and atropine for hypoxia and bradycardia, normal saline boluses for hypotension, or lavage and suctioning for hemorrhage. CONCLUSION:FFB is safe and effective for diagnostic and therapeutic use in critically ill pediatric patients.

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Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

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

Field-Ridley

Sethi

Murthi

et al. 2015

WJCCM

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“…[10][11][12] In principle flexible fibre-optic bronchoscopy in the intensive unit does not different from those performed in an bronchoscopic suite however, conditions in the ICU demand different considerations and precautions.…”

Section: There Is Little Consensus As To the Indications For Paediatrmentioning

confidence: 99%

The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV

Webster

Goussard

Gie

et al. 2017

Expert Review of Respiratory Medicine

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Bronchoscopy is an important investigation in the diagnosis and management of childhood respiratory diseases widely used in high income countries. There is limited information on value of paediatric bronchoscopy in low and middle income countries (LMIC). Aims and Objectives:Aim of this study was to describe the indications, findings and complications of paediatric bronchoscopy in a middle income country with a high prevalence of tuberculosis (TB) and HIV. Methodology:A retrospective analysis of a database which included all bronchoscopies on neonates and children over a 3.5 year period (January 2010 to June 2013) in a tertiary care children's hospital in South Africa. Results and Discussion:A total of 509 bronchoscopies, of which 502 (98%) were fibre-optic bronchoscopies, were performed on neonates (2.3%) and children (median age = 18 months; range 1 day-14.6 years)( (male=58%) of which 5.1% were HIV-infected. The main indications were: large airway compression 40% (n = 204) complicated pneumonia (25 %) and persistent stridor (15 %). Pathology was observed in 64% (n = 319) of bronchoscopes . The most common pathology seen was lymph node compression of the airways (21%), and upper airway pathology (12%). Interventional procedures were performed in 112 cases (22%), the commonest being removing foreign bodies removal (30%), endobronchial lymph node enucleation (30%) and transbronchial needle aspiration (20%). No major complications occurred during or following bronchoscopy. ConclusionThe diagnostic yield of paediatric bronchoscopy did not significantly differ from those reported from high income countries emphasising the importance of paediatric bronchoscopy in the management of childhood lung disease in LMICs.

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“…The spectrum of disease ranges from airway disease associated with congenital heart disease, acquired tracheabronchomalacia requiring long-term ventilation to subglottic stenosis requiring tracheostomy. Fiber-optic bronchoscopy in the ICU is required to assess the airways of these neonates and children to assure correct management [15][16][17][18][19][20]. Performing a bronchoscopy safely in the ICU requires a different skill set as in the ICU there is an increased risk of developing complications and managing them in an unfamiliar environment.…”

Section: Indications For Bronchoscopy In Children In Lmicmentioning

confidence: 99%

The need for bronchoscopic services for children in low and middle-income countries

Goussard

Gie

2016

Expert Review of Respiratory Medicine

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Flexible bronchoscopy in pediatric intensive care

Abstract: There is a high yield of positive findings from undertaking FB both anatomically and microbiologically. FB should be seen as a routine diagnostic and therapeutic tool in paediatric intensive care.

Cited by 28 publications

References 18 publications

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

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

The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV

The need for bronchoscopic services for children in low and middle-income countries

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