Bronchoscopy in the management of children from developing countries undergoing congenital heart surgery

Schnapper, Michael; Dalal, Ilan; Mandelberg, Avigdor; Sternfeld, Alona Raucher; Sasson, Lior; Domany, Keren Armoni

doi:10.1002/ppul.25869

Cited by 4 publications

(3 citation statements)

References 23 publications

(49 reference statements)

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“…The detection rate of pathogens was 78.6%, and 345 pathogens were detected, including 181 bacterial strains (52.46%), 66 mycoplasma strains (19.13%), 88 virus strains (25.51%) and 10 fungal strains (2.90%). A total of 67 patients (29.26%) were mechanically ventilated, and 58 patients were on the machine for more than 48 h. The median APACHE II score was 11 (4-42), and the median SOFA score was 8 (5)(6)(7)(8)(9)(10)(11)(12). The median length of hospital stay for all patients was 16 days, the median length of stay in the ICU was 10 days, and the number of days prior to admission (medical history) was 4 days.…”

Section: Baseline Characteristics Of the Study Populationmentioning

confidence: 99%

“…In the paediatric intensive care unit (PICU), FOB is generally used to identify the aetiology of acute respiratory failure in children, such as laryngeal obstruction and foreign bodies [1], and the study of bronchoalveolar lavage fluid (BALF) can assist in early identification of lung disease, pathogens and causes of partial infiltration [5]. Rejection in children who have undergone cardiopulmonary transplantation can be assessed by cellular changes in BALF [6]. In recent years, the use of FOB and BAL in paediatric patients has increased significantly, and the use of FOB and BAL in the PICU has received increasing attention; however, the impact of decisions about their management has not been fully evaluated in previous studies [7] on the diagnosis and treatment of pulmonary diseases.…”

Section: Introductionmentioning

confidence: 99%

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Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

Sang

et al. 2023

Ital J Pediatr

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Background There is still a lack of effective scoring criteria for assessing the severity of pulmonary infection associated with changes in the endobronchial lining of the bronchus in children. This study aimed to ascertain the timing and value of endoscopic scoring of fibreoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in children with severe pneumonia. Method The clinical data of 229 children with severe pneumonia treated with BAL in the Pediatric Intensive Care Unit of the First Affiliated Hospital of Xinxiang Medical University between November 2018 and December 2021 were collected. According to the severity of the disease, patients were divided into an invasive ventilation group and a non-invasive ventilation group, as well as an early BAL group (receiving BAL within 1 day of admission) and a late BAL group (receiving BAL 2 days after admission). A Student’s t-test, Chi-square test, receiver operating characteristic (ROC) curve and survival curve were used to analyse the bronchitis score, aetiology of BAL fluid and survival data. Results The scores of endoscopic mucosal oedema, erythema and pallor and the total score in the invasive ventilation group were higher than those in the non-invasive ventilation group (P < 0.05), and they were consistent with the Sequential Organ Failure Assessment (SOFA) scores. The secretion colour score was lower in the early BAL group than in the late BAL group (P < 0.05). On the bronchitis scores, which were evaluated using a ROC curve, the difference in the mucosal erythema, pallor, oedema and total score of the invasive and non-invasive groups was statistically significant (P < 0.05), which was consistent with the area under the ROC of the SOFA scores. Acute Physiology and Chronic Health Assessment II and SOFA scores after FOB were lower than those before treatment (P < 0.05). In terms of ICU hospitalisation days and total hospitalisation days, the time of the early FOB patients was shorter than that of the late FOB patients (P < 0.05). A total of 22 patients (9.61%) died. The Kaplan–Meier analysis and log-rank test showed that the survival rate of the non-invasive ventilation group was higher than that of the invasive ventilation group (P < 0.05). Conclusion This study found that FOB combined with BAL is an important method for the diagnosis and treatment of severe pneumonia. Early BAL can reduce hospitalisation and ICU time; however, it cannot improve the survival rate. The endoscopic score has a certain role to play in assessing the severity of pulmonary inflammation, but studies with a large sample are still needed to confirm this.

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Section: Baseline Characteristics Of the Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

Sang

et al. 2023

Ital J Pediatr

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“…Fiberoptic bronchoscopy, a commonly employed endoscopic procedure for diagnosing and treating respiratory diseases in children, demands meticulous consideration in selecting anesthesia due to its precision and safety requirements 1 – 3 . Given the distinctive characteristics of pediatric patients, marked by heightened physiological sensitivity and reduced tolerance, the choice of an appropriate anesthesia method is crucial to ensuring smooth examination progress and the safety of children 4 , 5 .…”

Section: Introductionmentioning

confidence: 99%

Investigation into the application of remimazolamin conjunction with low-dose propofolfor pediatricfiberoptic bronchoscopy

Chen,

Bao,

Shi

et al. 2024

Sci Rep

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This study delves into the effectiveness of combining remimazolam with low-dose propofol in pediatric fiberoptic bronchoscopy. Ninety children scheduled for fiberoptic bronchoscopy in our hospital were enrolled as research participants. Based on the intraoperative anesthetic drug regimen, the children were divided into three groups: group R (remimazolam 0.2–0.4 mg/kg), group P (propofol 1–3 mg/kg), and group RP (remimazolam0.2 mg/kg, propofol 0.5 mg/kg). Immediately post-anesthesia, group P exhibited lower blood pressure and heart rate (HR) compared to both group R and group RP (P < 0.05). As bronchoscope approached the glottis and epiglottis, group P continued to display lower blood pressure and HR compared to group R and group RP (P < 0.05). During lavage, group P maintained lower blood pressure and HR compared to both the R and RP groups (P < 0.05). Immediately post-anesthesia, group P demonstrated lower SpO2 compared to the R and RP groups (P < 0.05).During lavage, group P maintained lower SpO2 than group R and group RP (P < 0.05). In comparison with group R and group PR, group P showed shortened induction and recovery times (P < 0.05). The one-time entry success rate into the microscope was higher in group R than in group P, with the RP group showing an intermediate decreased (P < 0.05). Moreover, the cough score in R group was higher than in the P and RP groups (P < 0.05). Furthermore, the satisfaction rates of the RP group exceeded those of the R and P groups (P < 0.05). Remimazolam combined with low-dose propofol effectively balances the strengths and weaknesses of remimazolam and propofol, ensuring more stable hemodynamics, a lower incidence of adverse reactions, and optimal surgical conditions in pediatric fiberoptic bronchoscopy.

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Bronchoscopy in the management of children from developing countries undergoing congenital heart surgery

Schnapper

Dalal

Mandelberg

et al. 2022

Pediatric Pulmonology

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Objectives: To study the clinical characteristics and impact of bronchoscopy in children from developing countries, referred for cardiac surgery, through the "Save a Child's Heart" (SACH) organization. Methods:We performed a retrospective hospital-chart review of SACH children (0-18 years old) referred between 2006 and 2021 who underwent fiberoptic bronchoscopy. We examined demographics, congenital-heart-disease (CHD) types, bronchoscopy's indications and findings, subsequent recommendations, number of ventilation, and intensive-care-unit days. The primary outcome was percent changes in management and diagnosis, following the bronchoscopy. We included a control group matched-for-age and CHD type, who did not undergo bronchoscopy.Results: We performed 82 bronchoscopies in 68 children: 18 (26.5%) preoperatively; 46 (67.6%) postoperatively; and four (5.9%) both. The most prevalent CHDs were Tetralogy-of-Fallot (27.9%) and ventricular-septal-defect (19.1%). The main indications were persistent atelectasis (41%) and mechanical ventilation/weaning difficulties (27.9%). Bronchoscopic evaluations revealed at least one abnormality in 51/68 (75%) children. The most common findings were external airway compression (23.5%), bronchomalacia (19.1%), and mucus secretions (14.7%). Changes in management were made in 35 (51.4%) cases, with a major change made in 14/35 (40%) children. Compared to the control group, the children undergoing bronchoscopy were both ventilated longer (median 6 vs. 1.5 days, p < 0.0001) and stayed longer in the intensive care unit (median 1.5 vs. 18.5 days, p < 0.0001). Conclusion:A bronchoscopy is an important tool in the diagnosis and management of the unique group of children from developing countries with CHD referred for cardiac surgery. The results of our study, reveal a more complicated clinical course in children requiring bronchoscopy compared to controls.

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Bronchoscopy in the management of children from developing countries undergoing congenital heart surgery

Cited by 4 publications

References 23 publications

Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

Investigation into the application of remimazolamin conjunction with low-dose propofolfor pediatricfiberoptic bronchoscopy

Bronchoscopy in the management of children from developing countries undergoing congenital heart surgery

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