Incidence Rate and Factors Related to Post-Bronchoalveolar Lavage Fever in Children

Fonseca, Mariana; Camargos, Paulo Augusto Moreira; Taam, Rola Abou; Bourgeois, M. Le; Scheinmann, P.; Blic, J. de

doi:10.1159/000107737

Cited by 8 publications

(5 citation statements)

References 41 publications

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“…The postbronchoscopy fever rate was in accordance with a paediatric study 23. Others have reported lower rates (0%–38%) 24–30. The causes of this wide range in rates are unclear, but the studies vary greatly in patient population and design.…”

Section: Discussionsupporting

confidence: 77%

Complications and discomfort after research bronchoscopy in the MicroCOPD study

et al. 2020

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background Data on discomfort and complications from research bronchoscopy in chronic obstructive pulmonary disease (COPD) and asthma is limited. We present complications and discomfort occurring within a week after bronchoscopy, and investigate personal and procedural risk factors. Methods 239 subjects with COPD, asthma or without lung disease underwent research bronchoscopies as part of a microbiome study of the lower airways (the MicroCOPD study). Bronchoscopy was done in the supine position with oral scope insertion with the option of light conscious alfentanil sedation. Sampling consisted of protected specimen brushes, bronchoalveolar lavage, small volume lavage and for some, endobronchial biopsies. Bleeding, desaturation, cough, haemodynamic changes, dyspnoea and other events that required an unplanned intervention or early termination of bronchoscopy were prospectively recorded. Follow-up consisted of a telephone interview where subjects rated discomfort and answered questions about fever sensation and respiratory symptoms in the week following bronchoscopy. results An unplanned intervention or early termination of bronchoscopy was required in 25.9% of bronchoscopies. Three subjects (1.3%) experienced potentially severe complications, of which all recovered without sequelae. COPD subjects experienced more dyspnoea than controls. Sedation and lower age was associated with less unplanned intervention or premature termination. About half of the subjects (47.7%) reported fever. Discomfort was associated with postprocedural fever, dread of bronchoscopy, higher score on the COPD Assessment Test and never-smoking. In subjects undergoing more than one bronchoscopy, the first bronchoscopy was often predictive for complications and postprocedural fever in the repeated bronchoscopy. conclusion Research bronchoscopies were not associated with more complications or discomfort in COPD subjects. 47.7% experienced postbronchoscopy fever sensation, which was associated with discomfort.

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Section: Discussionsupporting

confidence: 77%

Complications and discomfort after research bronchoscopy in the MicroCOPD study

et al. 2020

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“…Although very safe, FFB may present few complications like hypoxemia, bleeding, hemodynamic alterations like bradycardia, or sometimes post-bronchoscopy fever. 7 , 12 In our study, complications were noted in only 19% patients. These complications are reported earlier mainly in ICU settings by Nussbaum and Bar-Zohar and Sivan.…”

Section: Discussioncontrasting

confidence: 50%

Flexible Fiber-optic Bronchoscopy-directed Interventions in Children with Congenital Heart Diseases

Agarwal¹,

Joshi²,

Chhawchharia³

2020

Indian Journal of Critical Care Medicine

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Objective In children, pulmonary and cardiac diseases are closely associated, and their integrated evaluation is important. Flexible fiber-optic bronchoscopy (FFB) can be used for both diagnostic and therapeutic purposes in pediatric cardiac intensive care units (PCICU). The objective of this study was to evaluate the utility of FFB in children with congenital heart disease (CHD). Materials and methods A retrospective, descriptive study was conducted at a tertiary care center in pediatric patients who underwent FFB in PCICU over a period of 6 years (2012–2017). Results Total 71 bronchoscopies were done in 58 patients with CHD with median age and weight of 2.5 months and 3.4 kg, respectively. Total of 20 different cardiac lesions were present among patients who underwent FFB. While 38 (53.5%) and 30 (42.3%) procedures were performed in pre-op and postoperative patients, respectively, 3 intraoperative bronchoscopies were also performed. The main indications for FFB were persistent atelectasis (42/71), prolonged oxygen requirement (13/71), stridor (8/71), and suspected airway anomaly (6/71). Tracheobronchitis was the commonest bronchoscopy finding (51/71, 71.8%) followed by tracheobronchomalacia (27/71, 38.3%). Cause of stridor detected in 7/8 cases. Associated preoperative and postoperative respiratory complications were detected and necessary interventions were done. These included slide tracheoplasty (5/58), tracheostomy (5/58), antibiotic change based on bronchoalveolar lavage (BAL) cultures (11/71), and continued positive pressure ventilation (4/71). Nonconsequential complications were transient hypoxemia (10/71), bleeding (2/71), and transient bradycardia (1/71). Conclusion Bedside FFB is a safe and a valuable diagnostic tool that also helps in guiding interventions in children with cardiac diseases. How to cite this article Sachdev A, Chhawchharia R, Gupta D, Gupta N, Joshi R, Agarwal N. Flexible Fiber-optic Bronchoscopy-directed Interventions in Children with Congenital Heart Diseases. Indian J Crit Care Med 2020;24(5):340–343.

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“…Of note, post-bronchoalveolar lavage fever is a reported complication in some studies [6], [11], [33]. While the origin of this fever is unknown, it is transient and more common in children less than two years old [33].…”

Section: Discussionmentioning

confidence: 99%

Flexible bronchoscopy in children

Terkawi

Altirkawi

Terkawi

et al. 2016

International Journal of Pediatrics and Adolescent Medicine

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Background and objectivesThe flexible bronchoscope has become widely used by pediatric pulmonologists as a diagnostic and therapeutic tool. Nevertheless, there are several gaps in our knowledge to help refine its use and reduce its complications. In this study, we aimed to evaluate the utility and complications of pediatric bronchoscopy.Design and settingWe conducted a retrospective review of bronchoscopy cases between March 2006 and April 2015 at a tertiary care medical center (King Fahad Medical City). One-hundred forty nine patients were studied.Patients and methodsWe evaluated how bronchoscopy contributed to the patients' diagnosis, assessed the accuracy of bronchoalveolar lavage white blood cell count (BAL WBC) to differentiate between infectious and non-infectious conditions, assessed the ability of clinical factors to predict high risk of desaturation during bronchoscopy, and finally summarized the reported procedural complications.ResultsWe found pediatric bronchoscopy was a crucial diagnostic (confirming, ruling out, and discovering unexpected diagnosis) and therapeutic tool. The accuracy of BAL WBC counts is poor (AUC (95% CI) = 0.609 (0.497–0.712)); however, using two cutoff values (≤10 WBCs (sensitivity = 84.44% and specificity = 29.27%) to rule out, and ≥400 WBCs (sensitivity = 33.33% and specificity 81.49%) to rule in infection) helped in early differentiation between infectious and non-infectious conditions. From the factors that we test, none we found predictive of desaturation. The most common procedural complication was desaturation (pooled incidence (95% CI) = 13 (8–19)%) followed by cough, mild airway bleeding, and spasm.ConclusionsFlexible bronchoscopy is an important and relatively safe diagnostic and therapeutic tool in pediatric medicine, and utilization of this service should be encouraged after a careful consideration of which patient needs this procedure and a rigorous estimate of its pros and cons.

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Incidence Rate and Factors Related to Post-Bronchoalveolar Lavage Fever in Children

Cited by 8 publications

References 41 publications

Complications and discomfort after research bronchoscopy in the MicroCOPD study

Complications and discomfort after research bronchoscopy in the MicroCOPD study

Flexible Fiber-optic Bronchoscopy-directed Interventions in Children with Congenital Heart Diseases

Flexible bronchoscopy in children

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