Flexible fiberoptic bronchoscopy in children on extracorporeal membrane oxygenation

Abstract

Bleeding is one of the most feared complications of veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO), and is also a potential complication of flexible fiberoptic bronchoscopy (FFB). We retrospectively reviewed 14 patients who underwent FFB procedures with bronchial washings (BW) and bronchoalveolar lavage (BAL) to evaluate the safety of this procedure in children on ECMO. Standard FFB with BAL/BW technique was used after stabilization on ECMO. Three patients underwent two procedures each, and one patient underwent three, for a total of 19 procedures. No significant complications, such as bleeding have occurred. Three patients required additional ECMO support shortly after FFB. After the 16 procedures done for atelectasis, seven patients improved radiographically, three had increased opacifications, and six were unchanged. The remaining three patients had suspected pulmonary infections, and in each, therapeutic decisions were guided by the BAL results. Lung compliance was unchanged or improved after 11 of 13 procedures. We conclude that FFB with BAL/BW in children on ECMO is safe and may benefit certain patients.

Flexible bronchoscopy in pediatric intensive care

“…Broncho-alveolar lavage (BAL) was undertaken by a standardized and previously described technique of 1 ml/kg 0.9% saline. 2,3 Up to four BAL specimens were taken in each area with minimal dwell time with all specimens being separately cultured and results reported in a semi-quantitative fashion. Moderate to heavy bacterial growth, as reported by the microbiologist, of a single organism was taken as a significant finding.…”

Official American Thoracic Society Technical Standards: Flexible Airway Endoscopy in Children

“…Atelectasis FAE can safely be performed in infants and children with atelectasis in a variety of settings (80)(81)(82)(83)(84). When atelectasis is not resolving and is problematic, FAE should be considered.…”

“…Reports suggest FAE utility in the diagnosis of the etiology of atelectasis in 62 to 100% of cases (80,82,83,85). Therapeutically, FAE has been used to relieve atelectasis in a variety of diseases, including hyaline membrane disease, pneumonia, CF, and plastic bronchitis, with variable success (81,(86)(87)(88)(89). The use of sterile saline washes is standard practice.…”

Pediatric bronchoscopy

“…66,67 With small¯exible endoscopes (e.g., 2.2 mm OD), even premature infants can be endoscoped through the endotracheal tube. 66,67 With small¯exible endoscopes (e.g., 2.2 mm OD), even premature infants can be endoscoped through the endotracheal tube.…”