A survey of pediatric flexible bronchoscopy in India

Abstract

Background: A bronchoscopy is an essential tool in pediatric pulmonology. However, the practices involved in the procedure are variable.Objective: To evaluate prevalent practices and variations in pediatric flexible bronchoscopy in India.Methods: An online survey was conducted via Google forms between September 2018 and March 2019. We circulated the survey among members of various respiratory societies and personal contacts. Physicians performing pediatric flexible bronchoscopy were requested to respond. The survey had 95 questions in seven domains: demographics, patient preparation, sedation, procedural aspects, monitoring, bronchoscope cleaning, and complications. Results:The survey received 24 complete responses; the respondents were from 14 cities. Pediatric bronchoscopy was done mainly for diagnostic purposes. Most (19, 79%) respondents reported using conscious sedation for the procedure. The preferred regimen for sedation was midazolam plus fentanyl [9 (37.5%)]. Atropine was used routinely by 4 (16%). For topical anesthesia, nebulized lignocaine only, both nebulized and spray as go lignocaine, and spray as go lignocaine only were used by 1 (4.2%), 6 (25%), and 17 (71%) respondents, respectively. The methods of providing oxygen during bronchoscopy were free flow (9, 37.5%), nasal prongs (8, 33.3%), mask (6, 25%), and laryngeal mask airway (1, 4.2%). The common therapeutic procedures included removal of mucus plugs (17, 71%), bronchoscopic intubation (11, 45%), and foreign body removal (10, 41%). The number of aliquots used by respondents for bronchoalveolar lavage varied from 2 to 6, and the volume for each aliquot was also varied (1-2 ml/kg or 5-10 ml). Almost all the respondents reported complication rates of less than 5%. Conclusion:There is a considerable variation in pediatric flexible bronchoscopy practices across the country, highlighting the need to develop a uniform guideline.

Practices and perspectives on advanced diagnostic and interventional bronchoscopy among pediatric pulmonologists in the United States

“…There have been surveys of pediatric flexible bronchoscopy, but none have addressed practice of advanced and interventional bronchoscopy. 16,17 The demographics indicate that our survey respondents are more likely to self-report being male and non-Hispanic white. This is reflective of the American Academy of Pediatrics pediatric pulmonology workforce survey from 2014 with only 37% of respondents self-reporting as female.…”

“…This is the first study to characterize current practices and perspectives regarding advanced diagnostic and interventional bronchoscopy procedures among pediatric pulmonologists in the United States. There have been surveys of pediatric flexible bronchoscopy, but none have addressed practice of advanced and interventional bronchoscopy 16,17 …”

Associated Risk Factors and Diagnostic Value of Fiberoptic Bronchoscopy for Protracted Bacterial Bronchitis in Children

“…Fiberoptic bronchoscopy with alveolar lavage was performed under local anesthesia, and the duration of the examination was generally controlled at about 30 minutes. Local anesthesia involves spraying lidocaine solution into the nasal cavity and throat through a watering can, spraying into the main bronchus and left and right bronchus via a fiberoptic bronchoscope, and an intravenous infusion of midazolam (0.1–0.3 mg/kg) for sedation [ 16 ]. Before surgery, the operator will determine whether there are signs of large sheet shadow change in the lungs according to the chest image of the child, so that the relevant lesion area can be repeatedly lavage during the operation.…”