Flexible Endoscopy of the Pediatric Airway

Green, Christopher G.; Eisenberg, Jay D.; Leong, Albin; Nathanson, Ian; Schnapf, Bruce M.; Wood, Robert E.

doi:10.1164/ajrccm/145.1.233

Cited by 88 publications

(30 citation statements)

References 15 publications

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“…Furthermore, FFB can be used for therapeutic interventions such as removal of obstructions and re-expansion of collapsed lung. Despite a consensus statement adopted by the American Thoracic Society in 1991, and guidelines by the European Respiratory Journal in 2003, there are no specific guidelines for FFB in critically ill pediatric and neonatal patients [9,10] .…”

Section: Discussionmentioning

confidence: 99%

“…Cohort, case control, or randomized controlled trials that reported either diagnostic, therapeutic, or adverse events related to FFB were included. Articles focusing on bronchoscopy in patients with foreign body aspiration were excluded, as rigid bronchoscopy is indicated for removal of foreign bodies [9] . For the purposes of this systematic review, we defined a positive diagnostic FFB as one identifying anatomic or functional airway abnormality, foreign body/ obstruction, mucus plugging/atelectasis, hemorrhage, and/or airway inflammation.…”

Section: Methodsmentioning

confidence: 99%

“…The recommendation to perform FFB in neonates to evaluate difficulty weaning from mechanical ventilation is in accord with the European Respiratory Journal guidelines, which support the use of FFB in neonates to evaluate for subglottic stenosis and other airway abnormalities. However, recommendations for FFB for asthmatic and ECLS dependent populations are not specified in either the European Respiratory Journal or the American Thoracic Society guidelines [9,10] . We found that 2.1% of pediatric patients who undergo FFB had adverse events that required a medical intervention, which is similar to the 2% (range 1.6%-4%; 17/814) reported in the adult populations [38,39] .…”

Section: Hypotension Hemorrhage Othermentioning

confidence: 99%

“…Furthermore, one of the concerns regarding the use of FFB in pediatric populations is the anesthetic risk in these patients. According to the pediatric guidelines by the American Thoracic Society, adverse reactions to medications account for at least half of complications associated with FFB [9] . In many of the included studies, it was difficult to differentiate anesthetic complications from procedural complications.…”

Section: Limitationsmentioning

confidence: 99%

“…However, the guidelines for adult FFB cannot necessarily be extrapolated to children given the smaller airways, differences in pulmonary diagnoses, and sedation needs for FFB in children. Guidelines about the use of FFB in pediatric patients are over a decade old [9,10] . Despite increased use of FFB by pediatric pulmonologists, intensivists and anesthesiologists, there are no current guidelines regarding the safety and utility of FFB in the pediatric critically ill population.…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Hypotension Hemorrhage Othermentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Field-Ridley

Sethi

Murthi

et al. 2015

WJCCM

View full text Add to dashboard Cite

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Yield from flexible bronchoscopy in children

et al. 1997

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Flexible fiberoptic (FO) bronchoscopy can now be undertaken readily in children using topical anesthesia and light sedation and has largely supplanted rigid open tube (OT) bronchoscopy for diagnostic purposes. The present study examined the contribution of the FO bronchoscope to clinical management in children presenting with specific types of problems. We examined the first 200 consecutive flexible bronchoscopies performed in 1995 in children under 18 years of age (median age, 2.27 years). Indications for bronchoscopy were noisy breathing (26.5%), recurrent pneumonia (21.0%), suspected pneumonia in an immunocompromised patient (10.5%), atelectasis or bronchial toilet (12.5%), possible foreign body aspiration (13.0%), and miscellaneous other reasons (16.5%). Inspection of the airway was abnormal in 67.0% of all investigations and made a clinically meaningful contribution to management in 67.5%, especially in those with noisy breathing (98.1%), possible foreign body aspiration (100%), and atelectasis (76.0%). Bronchoalveolar lavage (BAL) cytology was abnormal in 80.4% of the 107 lavages, but contributed little to management except in those with recurrent pneumonia (73.8%). Bacteria were isolated in 26.6% of the 109 specimens cultured, but this finding rarely affected management. Fungi were isolated in 47.4% of the 19 lavages in the immunocomprised group. Together, inspection, BAL and microbiology contributed to management in a mean of 90.5% (range, 76.2–100%) of patients in the various groups. We concluded that a high yield of clinically meaningful information can be expected from FO bronchoscopy in children when coupled with BAL and microbiological studies of lavage fluid. Pediatr. Pulmonol. 1997; 23:261–269 © 1997 Wiley‐Liss, Inc.

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