Predictive value of bronchoscopy after infant cardiac surgery: a prospective study

Nayak, P.P.; Sheth, Javal; Cox, Peter N.; Davidson, Leanne; Forte, Vito; Manlhiot, Cedric; McCrindle, Brian W.; Schwartz, Steven M.; Solomon, Melinda; Arsdell, Glen S. Van; Sivarajan, V. Ben

doi:10.1007/s00134-012-2702-1

Cited by 8 publications

(8 citation statements)

References 15 publications

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“…Almost all FFB were performed at the bedside, with the exception of routine evaluation for esophageal atresia, where the procedure took place in the operating room [14] . The patient populations undergoing FFB included patients evaluated for a spectrum of anatomic airway or intrinsic pulmonary abnormalities, including patients with congenital heart disease (CHD) (7/27; 26% studies) and patients on extracorporeal life support (ECLS) (4/27; 15% studies) [4,[15][16][17][18][19][20][21][22][23] . FFB was performed multiple times on patients in 55% of the studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…De Blic et al [4] reported that in children with CHD, FFB findings of external compression of the airways by cardiovascular anomalies prompted earlier cardiac surgery in 50% (5/10) [4] . Twenty-one studies reported an overall diagnostic yield of 82% using FFB (range 45.2%-100%; 3791/4 622) [3][4][5][14][15][16][17][18][20][21][22][23][24][25][26][27][28][29][30][31][32][33] . [27] , 2011 [20,24,31] .…”

Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

“…[27] , 2011 [20,24,31] . Lower airway findings included airway stenosis, compression, malacia, mucus plugs, thrombus, and malpositioned endotracheal tube [3,14,15,17,18,20,21,23,24,31,32] . The diagnostic yield of FFB varied amongst different patient populations.…”

Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

“…The populations with the highest diagnostic yield of FFB were patients with extubation failure, patients with CHD, patients with hemoptysis, and patients undergoing ECLS. In patients with extubation failure, FFB identified a cause, such as mucus plugs, laryngotracheomalacia, laryngeal trauma/edema or compression, in 69.9% (range 50%-90.5%; 51/73) [3,[16][17][18][19][20][21]24,27,31,32] .…”

Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

“…External airway compression was the most commonly reported finding [15][16][17][18]20,21,34] . In patients with hemoptysis, FFB identified a cause in 56% of patients (range 20%-100%; 14/25) [5,15,25,30] .…”

Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

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Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: A systematic review

Field-Ridley

Sethi

Murthi

et al. 2015

WJCCM

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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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Section: Study Characteristicsmentioning

confidence: 99%

Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

Section: Diagnostic Yield Of Ffbmentioning

confidence: 99%

See 3 more Smart Citations

Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: A systematic review

Field-Ridley

Sethi

Murthi

et al. 2015

WJCCM

View full text Add to dashboard Cite

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Three-Dimensional Rotational Angiography in the Assessment of Vascular and Airway Compression in Children After a Cavopulmonary Anastomosis

et al. 2015

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The aim of the study was to examine the role of three-dimensional rotational angiography (3DRA) in assessing vascular and airway narrowing in children with a bidirectional cavopulmonary anastomosis (BCPA). The course of children with single ventricle physiology is often complicated by left pulmonary artery (LPA) and/or bronchial stenosis and may be related to aortic compression. 3DRA may be useful in evaluating this complex anatomy and possible mechanisms for the observed obstruction. Clinical data and imaging (2D angiography and 3DRA) of children with a BCPA were reviewed retrospectively. Measurements were taken at similar locations along the pulmonary arteries in both modalities and in the airways on 3DRA. Twenty-five children with a previous BCPA were assessed at mean age of 3.1 ± 2.0 years and weight of 13.6 ± 3.6 kg. Excellent correlation was found between 3DRA and 2D angiographic LPA measurements (r = 0.89, p < 0.0001). Twelve children had qualitative LPA stenosis on 3DRA, with a stenotic dimension of 6.6 ± 2.2 mm on 2D angiography and 6.8 ± 1.9 mm on 3DRA (r = 0.94, p < 0.0001). Ten cases with LPA stenosis also had bronchial stenosis (83 %). Qualitative airway assessment correlated with quantitative bronchial dimensions from 3DRA-derived tomographic images: Bronchial stenosis measured 4.4 ± 1.6 versus 5.9 ± 1.1 mm in those with a normal appearing bronchus (p = 0.009). Hybrid patients (initial palliation with bilateral pulmonary artery banding and arterial ductal stenting, n = 5) and all patients with a Damus-Kaye-Stansel (DKS) anastomosis (n = 9) were more likely to have LPA and left bronchial stenosis (OR 7.7, p = 0.04). 3DRA is a useful and accurate tool in assessment of LPA and airway narrowing after BCPA. Hybrid and DKS patients are more prone to LPA and bronchial stenosis, and 3DRA can provide insight into the mechanism.

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Bronchial compression following pulmonary artery stenting in single ventricle lesions: how to prevent, and how to decompress

et al. 2015

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In SV lesions accompanied by branch PA stenosis, thorough preparation via cross-sectional imaging is mandatory, including simultaneous bronchoscopy and cardiac catheterisation in selected cases, to rule out any airway compression before considering endovascular stent implantation. If a PA stent's compression has already caused severe bronchial obstruction, our balloon-splinted decompression technique should be considered.

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Predictive value of bronchoscopy after infant cardiac surgery: a prospective study

Cited by 8 publications

References 15 publications

Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: A systematic review

Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: A systematic review

Three-Dimensional Rotational Angiography in the Assessment of Vascular and Airway Compression in Children After a Cavopulmonary Anastomosis

Bronchial compression following pulmonary artery stenting in single ventricle lesions: how to prevent, and how to decompress

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