Role of Flexible Bronchoscopy in Ventilator-Dependent Neonates

Bhat, Javeed I.; Charoo, Bashir Ahmad; Zahoor, Shihab; Ahmad, Qazi Iqbal; Ahangar, Ambreen Ali

doi:10.1007/s13312-020-1996-2

Cited by 10 publications

(9 citation statements)

References 15 publications

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“…21 Previous studies reported abnormal FB findings in 69%-80% of the patients in pediatric ICU 7,17,18 which was even higher in neonatal ICU patients (79%-98%), compared to adult patients in ICU (44%). [22][23][24] In our study, abnormal findings, were found in 91% of the patients. A high proportion of neonatal ICU patients (25%) may explain the high rate of abnormal findings in our study.…”

Section: Discussionsupporting

confidence: 56%

Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study

Atağ

Ünal

Yazan

et al. 2021

Pediatric Pulmonology

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Introduction: Flexible bronchoscopy (FB) is frequently used for assessment and treatment of patients with respiratory diseases. Our aim was to investigate the contribution of FB to diagnosis and therapy in children admitted to the intensive care units (ICU) and to evaluate the safety of FB in this vulnerable population.Methods: Children less than 18 years of age who underwent FB in the five neonatal and pediatric ICUs in Istanbul between July 1st, 2015 and July 1st, 2020 were included to the study. Demographic and clinical data including bronchoscopy indications, findings, complications, and the contribution of bronchoscopy to the management were retrospectively reviewed.Results: One hundred and ninety-six patients were included to the study. The median age was 5 months (range 0.3-205 months). The most common indication of FB was extubation failure (38.3%), followed by suspected airway disease.Bronchoscopic assessments revealed at least one abnormality in 90.8% patients. The most common findings were airway malacia and the presence of excessive airway secretions (47.4% and 35.7%, respectively). Positive contribution of FB was identified in 87.2% of the patients. FB had greater than 1 positive contribution in 138 patients and 80.6% of the patients received a new diagnosis. Medical therapy was modified after the procedure in 39.8% and surgical interventions were pursued in 40% of the patients. Therapeutic lavage was achieved in 18.9%. There were no major complications. Conclusion:Flexible bronchoscopy is a valuable diagnostic and therapeutic tool in neonatal and pediatric ICUs and is not associated with major complications.

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Section: Discussionsupporting

confidence: 56%

Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study

Atağ

Ünal

Yazan

et al. 2021

Pediatric Pulmonology

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“…[7] However, extubation failure continues to be a problem in newborns and requires evaluation of the airways. [6,8] In our study, extubation failure that occurred in half of the patients was the most common indication. Extubation could be performed without tracheostomy in 30% of these patients with treatments given according to FB and BAL results.…”

Section: Discussionmentioning

confidence: 63%

“…Our results are consistent with the results of previously published studies conducted among NICU patients reporting a 48-52% incidence of airway malacia. [6,13,18] Nosocomial pneumonia in pediatric and NICUs is associated with prolonged hospitalization, high mortality, and high health-care costs. Furthermore, pneumonia is the most common empirical antibiotic indication in the PICU.…”

Section: Discussionmentioning

confidence: 99%

“…Bronchoalveolar lavage (BAL) was performed with the use of normal saline with a volume of 3 mL/kg administered in three divided doses. [2,6] BAL was taken from a segmental bronchus based on radiographic findings or findings at the time of the bronchoscopy, as well as routinely from the lingula and right middle lobe. BAL was sent for bacterial and fungal cultures.…”

Section: Methodsmentioning

confidence: 99%

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The value of flexible bronchoscopy in neonatal intensive care unit

Atağ¹

2021

South Clin Ist Euras

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Objective: Flexible bronchoscopy (FB) is a safe and valuable tool for the assessment and treatment of patients in neonatal intensive care units (NICUs) with respiratory diseases. Methods:All neonates who underwent FB in the NICU between July 2014 and July 2020 were included in the study. All demographic and clinical data including FB indications, the FB procedure performed and FB findings, FB complications, and the contribution of FB to the management were examined.Results: Forty-eight patients underwent FB. Twenty-two (45.8%) of them were male. The median age was 44 days (26.2-59.7). The most common indication for FB was extubation failure at 50%, followed by suspected airway disease at 33%. Bronchoscopic assessments revealed at least one abnormality in 46 (95.8%) infants. Bronchoalveolar lavage (BAL) was performed in 41 (85.4%) patients. FB contributed to the management in 46 (93.8%) of the patients. Based on FB results, 16 of 48 (33.3%) patients received a diagnosis by bronchoscopy, and medical treatments were revised in 23 (48%) patients. A successful therapeutic lavage was made in 7 (14.6%) of patients. Surgical interventions were performed in 28 (58.3%) of the patients. Conclusion:FB has an important value in the diagnosis and management of respiratory disorders in NICU. Direct visualization of the airways, microbiological assessment of BAL, and removal of mucus plugs allow the clinicians to make an accurate diagnosis and provide appropriate treatment options, including airway surgical procedures.

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“…Flexible bronchoscopy (FB) has become a progressively popular diagnostic method for airway evaluation in children[ 1 , 2 ]. Also, when mask ventilation or tracheobronchial intubation (TI) is expected to be challenging, FB is advantageous in airway safety when it is used to guide TI[ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Tracheobronchial intubation using flexible bronchoscopy in children with Pierre Robin sequence: Nursing considerations for complications

Ye¹,

Zhang²,

Xu³

et al. 2022

WJCC

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BACKGROUND It has been shown that children with Pierre Robin sequence (PRS) have a higher risk of difficult intubation before surgery. When mask ventilation or tracheobronchial intubation is expected to be challenging, flexible bronchoscopy (FB) is advantageous in airway safety when it is used to guide tracheobronchial intubation (TI). AIM To evaluate the complications of TI using FB in children with PRS and explore the effect of nursing services on postoperative complications. METHODS One hundred and five children with PRS underwent TI using FB before early mandibular distraction osteogenesis. One hundred and eight children with common pneumonia who did not have a difficult airway were set as the control group. Demographic data, success rates of TI, time required for TI, number of TI attempts, and the incidence of postoperative complications were assessed. Besides, the strategies used to attenuate complications were investigated. RESULTS The success rate of TI was 100% in children with PRS, while the success rate at the first attempt in the PRS group was significantly lower than that in the control group (88.6% vs 98.2%, P = 0.005). The time required for TI in the PRS group was markedly longer than that in the control group ( P < 0.001). Children in the PRS group required repetitive operations to enter the glottis successfully ( P = 0.017). The incidence of complications was noticeably higher in the PRS group (50/105, 47.6%) than in the control group (36/108, 33.3%) ( P = 0.034). Seven of 105 PRS children experienced laryngeal edema (LE) (6.7%), compared with one (0.9%) in the control group ( P = 0.034). Out of the seven patients who had LE, all were reintubated and managed with steroids: six recovered with inhaled steroids alone before extubated, and one was given systemic corticosteroids before recovery. CONCLUSION FB contributes to a high success rate of TI in children with PRS. To prevent LE, operators should pay more attention to catheter material, catheter lubrication and intubation time.

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Role of Flexible Bronchoscopy in Ventilator-Dependent Neonates

Cited by 10 publications

References 15 publications

Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study

Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study

The value of flexible bronchoscopy in neonatal intensive care unit

Tracheobronchial intubation using flexible bronchoscopy in children with Pierre Robin sequence: Nursing considerations for complications

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