Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres

Abstract

We have undertaken a survey to establish current practices and differences in the use of bronchoscopes in children in European centres.A questionnaire was sent to all 220 members of the Paediatric Assembly of the European Respiratory Society (ERS). The questions concerned the following points: indications for bronchoscopy; site of bronchoscopy; type of sedation; any oxygen supplementation during the procedure; number of procedures performed in the previous 12 months; number of procedures performed in the neonatal intensive care unit; number of bronchoalveolar lavages (BALs); side-effects during and after the procedures; and diagnostic yield.Fifty one European centres (40.8% of the European centres contacted) took part in the study. A total of 7,446 bronchoscopies had been performed in the last 12 months: 4,587 using the flexible bronchoscope and 2,859 using the rigid bronchoscope. At centres using only the fibreoptic bronchoscope, the most frequent indication was "recurrent/persistent pneumonia" (17%); at centres using only the rigid bronchoscope, it was "foreign body inhalation" (36.7%); at centres using both methods, the most frequent indication was "other indications" (23.9%).In 12 months, 2,231 BALs were performed: 1,419 in immunocompetent children and 812 in immunocompromised patients. In centres using only the fibreoptic bronchoscope, the highest yield was for "stridor" (81%); in centres using only the rigid bronchoscope, the highest yield was for "persistent atelectasis" (68%); and in centres using both instruments, it was for "foreign body inhalation" (93%).The results of the study suggest that bronchoscopy in children is now a wellestablished procedure at several European centres, while others are just beginning to use this technique. Eur Respir J 1997; 10: 1761-1766 In the past, bronchial endoscopy called for the use of the rigid bronchoscope and was consequently used very infrequently in children [1]. The advent of thin and ultrathin fibreoptic bronchoscopes has considerably extended the use of this procedure [2], even in the neonatal field [3].Since there is no European survey of the highly specialized paediatric pneumology centres where rigid and flexible bronchoscopes are routinely used in children, the Paediatric Bronchology Group of the European Respiratory Society (ERS) prepared a questionnaire and sent it to all member paediatricians with a view to gaining a picture of the situation in Europe and obtaining information on the most common indications for paediatric bronchoscopy, the number of procedures performed each year, where such procedures are carried out, what type of sedation is used and what results are obtained. Materials and methodsThe questionnaire was sent in March 1995 to all 220 members of the Paediatric Assembly listed on the ERS Roster of July 1993, using the Scientific Group Code 07.01, .02, .03, .04, .05, .06 and .07. There were 172 paediatricians from 125 European centres, and 48 from 43 centres outside Europe. The questions concerned the following points: the most c...

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

“…The primary diagnosis diagnosis prior to bronchoscopy were recurrent or persistent pneumonia (17%), followed by wheezing unresponsive to treatment (15.5%), persistent atelectasis (14%) and stridor (13%). 8 The findings at bronchoscopy of our study were in keeping with reports in the literature from mostly high income countries with normal anatomy noted in (21.6%) of bronchoscopes, inflammation of the airways (14%), subglottic stenosis (4.4%) and foreign body aspiration (7.0%). The notable expectation was TB lymph node compression of the airways which occurred in 21% of cases.…”

“…European centres demonstrated that the indications for paediatric bronchoscopy differed according to the available instruments 8 . In centres using only fibre-optic bronchoscopes, the commonest indication was stridor (81%) while in in centres only using rigid bronchoscopy, the commonest indication was "persistent atelectasis" (68%).…”

“…In centres using only fibre-optic bronchoscopes, the commonest indication was stridor (81%) while in in centres only using rigid bronchoscopy, the commonest indication was "persistent atelectasis" (68%). In centres where both rigid and fibre-optic bronchoscopes were available the commonest indication was of foreign body inhalation (93%) 8 .…”

“…3 Interventional bronchoscopy has resulted in new procedures such as the sealing of trachea-oesophageal fistulas, bronchooesophageal fistulas and post pneumonectomy stump leaks in children [3][4][5] . The vast majority of publications on bronchoscopy are from high income countries such as the United States, Europe and Israel [6][7][8][9] . These studies have described the bronchoscopic findings and the value of paediatric bronchoscopy in clinical and research settings in these high income countries.…”

Paediatrics in Barcelona

“…It is difficult to compare these results with previously published data. Apart from a few studies describing single-centre experiences, only one large multicentre study has been published so far [153]. In this survey, 41% of the addressed European centres returned the questionnaire sent to 220 members of the ERS Paediatric Assembly.…”