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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Background:The process of myelination peaks in middle age followed by myelin breakdown and loss. Investigations of information processing speed performance across the lifespan reveal a trajectory that parallels myelination and subsequent myelin breakdown. Myelin breakdown may result in a progressive "disconnection" of widely distributed neural networks and may underlie age-related cognitive decline and Alzheimer's disease (AD). Objective(s): This study tests the "myelin model"/hypothesis that in older individuals, myelin breakdown in late-myelinating regions is associated with slowed processing speed and contributes to the continuum of cognitive decline that ultimately results in AD. Methods: Healthy older (Ͼ55 years) individuals (Nϭ92) and 8 subjects with Alzheimer's disease (AD) had neurocognitive testing. The late-myelinating frontal lobe white matter (Fwm) as well as early-and later-myelinating regions of the corpus callosum, the splenium (Swm) and genu (Gwm) respectively, were assessed using MRI and transverse relaxation rates (R 2 ) were calculated. R 2 is an indirect measure of white matter structural integrity; it declines with age-related myelin breakdown and is significantly lower in AD. Results: As hypothesized, cognitive processing speed tasks (Trails A and Digit Symbol) were significantly associated with R 2 in late-myelinating regions (Fwm, pϽ.0001 and Gwm, pϽ.004) but not in the early myelinating Swm region (pϾ.2). Conclusions: These data suggest that myelin breakdown in healthy older individuals underlies the age-related cognitive decline that ultimately results in AD. MRI measures of myelin breakdown and cognitive measures may be useful in AD primary prevention studies.