The clinical safety and efficacy of flexible bronchoscopy in a neonatal intensive care unit

Abstract

Flexible bronchoscopy (FB), developed in the 1960s, is widely used in the clinical practice of pediatrics and has demonstrated fundamental value in clinical diagnoses and treatment. However, as an invasive procedure, the use of FB is limited due to concerns regarding the tolerance of the procedure and the possible complications in neonatal units. Thus, the present study aimed to investigate the clinical safety and efficacy of flexible bronchoscopy (FB) in a neonatal intensive care unit (NICU). Neonates (n=54) who received FB in the NICU of Shanghai Children's Hospital between January 2012 and December 2016 were enrolled as the experimental group and another 54 neonates who required nebulization and tracheal secretion suction treatments were the control group. Indicators including blood gas, complete blood count, C-reactive protein (CRP), X-ray, patient breathing rate, temperature and blood pressure were monitored prior to and following the procedure. No significant differences in sex, gestational age, birth weight or postnatal age were observed between the experimental group and the control group (P>0.05). Among the 54 FB patients, several cases with side effect were identified, including 18 (33.3%) with respiratory tract stenosis, nine (16.7%) with malacia and stenosis and six (11.1%) with esophagotracheal fistula. Among the 54 members of the control group, 44 neonates (81.4%) were discharged with improved condition, five (9.3%) succumbed and five patients (9.3%) abandoned the treatment and left the hospital. Bronchoalveolar lavage demonstrated consistent results with respiratory secretion culture or tracheal tube culture. In comparison between the experimental and the control groups, no significant difference in pH, partial pressure of carbon dioxide (PCO 2 ), partial pressure of oxygen (PO 2 ) and HCO 3 was observed, while there were no statistical differences in the values of pH, PCO 2 and HCO 3 -(P>0.05). However, PO 2 was significantly increased, and CRP was significantly reduced, following FB procedure compared with prior to FB (P<0.05). No pneumothorax, shock, other severe complications, fever or diffused pneumonia were observed during or after FB. The data from the present study demonstrated that FB is a safe and effective strategy for the diagnosis and differentiation of neonatal respiratory diseases in NICU.

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

“…26,27 Airway malacia has been reported in 48-50% of ICU patients. 5,16,23 In our study, airway malacia such as laryngomalacia, tracheomalacia and bronchomalacia, isolated or in different combinations was the most common FB finding, and it was present in 51% of our patients in line with previously published studies. As would be expected, laryngomalacia was more common in children aged less than 5 months in our study.…”

“…Airway malacia may cause failed extubation attempts, decreased mucociliary clearance and secondary infections in ICUs 26,27 . Airway malacia has been reported in 48‐50% of ICU patients 5,16,23 . In our study, airway malacia such as laryngomalacia, tracheomalacia and bronchomalacia, isolated or in different combinations was the most common FB finding, and it was present in 51% of our patients in line with previously published studies.…”

“…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.…”

The clinical application of flexible bronchoscopy in a neonatal intensive care unit

“…Common clinical complications of FB include nasal trauma and epistaxis, laryngeal spasm, laryngeal edema, cough and/or bronchospasm, pneumothorax or mediastinal emphysema, hemorrhage, hypoxemia, and fever and infections ( 5 ). FB has been reported to be safe, with no surgery-related mortality in pediatric ICU and NICU ( 19 , 35 , 38 ). Minimal complications were reported in our study (transient hypoxemia in 35 neonates), supporting the findings that FB is a safe procedure when performed by experienced operators under proper monitoring.…”

The value of flexible bronchoscopy in neonatal intensive care unit

“…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.…”