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

Abstract

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.

The clinical application of flexible bronchoscopy in a neonatal intensive care unit

“…Our study reported that FB revealed at least one positive finding in 95.92% of the patients admitted to NICU. Previous research reported that 79–98% of patients in the NICU have at least one abnormality detected using FB ( 16 , 19 , 20 ). Herein, the high rate of abnormal findings may be secondary to infants’ reluctance to perform early FB, resulting in severe and persistent symptoms that precede FB.…”

“…Our study revealed that laryngomalacia was the most common cause of upper airway obstruction, recurrent dyspnea, stridor, and hoarseness in newborns. In a retrospective report of 196 bronchoscopies, it was documented that airway malacia was found in 47.4% of cases ( 19 ). In addition, a 60–70% incidence of laryngomalacia was reported in neonates and children with stridor ( 24 ).…”

“…Common clinical complications of FB include nasal trauma and epistaxis, laryngeal spasm, laryngeal edema, cough and/or bronchospasm, pneumothorax or mediastinal emphysema, hemorrhage, hypoxemia, and fever and infections ( 5 ). FB has been reported to be safe, with no surgery-related mortality in pediatric ICU and NICU ( 19 , 35 , 38 ). Minimal complications were reported in our study (transient hypoxemia in 35 neonates), supporting the findings that FB is a safe procedure when performed by experienced operators under proper monitoring.…”

Çocuklarda Fleksibl Bronkoskopi- Marmara Çocuk Göğüs Hastalıkları Deneyimi

“…Tekrarlayan alt solunum yolu enfeksiyonları (ASYE) (1 yıllık dönemde en az iki ,yaşam boyunca en az üç pnömoni epizodu), kronik öksürük (4 haftadan uzun süren öksürük), persistan hışıltı (astım tedavisine yanıt vermeyen olgularda devam eden hışıltı), stridor, persistan atelektazi, yapısal anomali şüphesi endikasyonları ve altta yatan bilinen hastalığa yönelik BAL alınması amacı ile FB gerçekleştirildi (10)(11)(12)(13).…”

“…BAL örneği steril bir numune kabına aktarıldı. 10000 kob/ml üzerindeki üreme mikrobiyolojik olarak anlamlı kabul edildi (10)." FB ile ilgili komplikasyonlar minör ve major olarak gruplandırılmıştır (14).…”