Objectives: To study the utility, safety, and effects of flexible fiberoptic bronchoscopy (FFB) on oxygenation status, ventilation parameters, and hemodynamics in mechanically ventilated children.Design: Retrospective study.Patients: Children aged >1 month to 18 years suffering from critical medical and surgical diseases.Results: First bronchoscopy data of 131 patients were analyzed. Indication, FFB findings, the microbiological yield from bronchoalveolar lavage, and medical and surgical interventions based on FFB results were recorded. Hemodynamic and ventilation parameters before, during, and 3 h after FFB were also captured. The majority of bronchoscopies were done for diagnostic purposes with a positivity rate of 90.8%. Retained mucopurulent secretion in the airways was the commonest finding in 60 patients. A cause for weaning or extubation failure could be identified in 83.3%. Post-FFB radiological resolution of atelectasis was seen in 34/59 (57.6%; p-value: 0.001) chest radiographs. Forty-seven medical and 25 surgical interventions were done depending on FFB and BAL findings. There was a significant drop in oxygenation parameters and a rise in heart rate during FFB (p-value: <0.0001). The peak inspiratory pressure, positive end-expiratory pressure, and mean airway pressure increased significantly during bronchoscopy (p value: <.0001) while patients were on pressure-regulated volume-controlled ventilation. All these changes reversed to pre-FFB levels. There were minor procedure-related complications. Conclusion: FFB was an important diagnostic and therapeutic tool for mechanically ventilated children and the results helped plan interventions. It was a safe procedure with transient reversible cardiopulmonary alterations.

There is a paucity of studies on the correlation between chest radiograph and ultrasound (US) in children. Our objective was to study the correlation between bedside chest radiograph and ultrasound findings in 413 children with 1002 episodes of chest radiograph and US enrolled for a prospective, double-blinded observational study in a multidisciplinary paediatric intensive care unit. Weighted κ statistic for agreement was different for right and left lungs and varied from 50% for left pleural effusion to 98% for right pneumothorax. Pulmonary oedema, pneumothorax and pleural effusion were diagnosed by ultrasound alone in a significantly higher number of patients as compared to chest radiograph (P = 0.001). Chest ultrasound is therefore deemed more sensitive than chest radiograph in detection of pleural effusion, pulmonary oedema and pneumothorax.

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