The need for bronchoscopic services for children in low and middle-income countries

Goussard, Pierre; Gie, Robert P.

doi:10.1586/17476348.2016.1162716

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…The diagnosis should also be considered in patients with acute pneumonia, especially if there is significantly reduced ventilation in the area of involvement as seen on chest radiography. Definitive diagnosis of foreign body aspiration is with bronchoscopy, but in the developing world the lack of access to bronchoscopy services [ 29 ] means that CT scan may be the main diagnostic modality, especially since organic foreign bodies will not be visible on the plain chest radiographs (Fig. 13 ).…”

Section: Foreign Body Aspirationmentioning

confidence: 99%

Computed tomography in children with community-acquired pneumonia

2017

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Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality of choice. Computed tomography (CT) on the other hand, is not currently a first-line imaging tool for children with suspected uncomplicated community-acquired pneumonia and is largely reserved for when complications of pneumonia are suspected or there is difficulty in differentiating pneumonia from other pathology. This review outlines the situations where CT needs to be considered in children with pneumonia, describes the imaging features of the parenchymal and pleural complications of pneumonia, discusses how CT may have a wider role in developing countries where human immunodeficiency virus (HIV) and tuberculosis are prevalent, makes note of the role of CT scanning for identifying missed foreign body aspiration and, lastly, addresses radiation concerns.

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Section: Foreign Body Aspirationmentioning

confidence: 99%

Computed tomography in children with community-acquired pneumonia

2017

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“…[1–3] It has been the challenge for anesthesiologist to select appropriate degree of anesthesia to meet the procedural needs. [4] Short-acting opioids, propofol, midazolam, newer drugs such as dexmedetomidine (DEX) have facilitated the conduct of this procedure.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of dexmedetomidine-remifentanil versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy

Zhang

Fang²,

Zhou³

2017

Medicine

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Flexible bronchoscopy has been more and more used for diagnosis and management diseases of respiratory system in pediatrics. Previous studies have reported that remifentanil (RF) and propofol are safe and effective for flexible bronchoscopy in adults, however, there have no trials evaluate the efficacy of DEX-RF versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy.We divided 123 children undergoing flexible bronchoscopy with DEX-RF or dexmedetomidine-propofol into 2 groups: Group DR (n = 63, DEX infusion at 1.0 μg kg−1 for 10 minutes, then adjusted to 0.5–0.7 μg kg−1 h−1; RF infusion at 1.0 μg kg−1 for 5 minutes, then adjusted to 0.05–0.2 μg kg−1 min−1), Group DP (n = 60, DEX infusion at 1.0 μg kg−1 for 10 minutes, then adjusted to 0.5–0.7 μg kg−1 h−1; propofol infusion at 10 μg kg−1 for 5 minutes, then adjusted to 0.05–0.1 μg kg−1 min−1). Ramsay sedation scale of the 2 groups was maintained at 3. Anesthesia onset time; total number of intraoperative patient movements; hemodynamics; total cumulative dose of DEX; amount of and time to first-dose rescue midazolam and lidocaine; postoperative recovery time; adverse events; and bronchoscopist satisfaction score were recorded.Anesthesia onset time was significantly shorter in DP (8.22 ± 2.48 vs 12.25 ± 6.43 minutes, respectively, for DP, DR, P = 0.015). The perioperative hemodynamic profile was more stable in DR than DP group. More children moved during flexible bronchoscopy in DP group (P = 0.009). Total dose of rescue midazolam and lidocaine was significantly higher in DR than in DP (P < 0.001). Similarly, the time to first dose of rescue midazolam and lidocaine was significantly longer in DP than in DR (P < 0.001). Total cumulative dose of DEX was more in DR than DP group (P < 0.001). The time to recovery for discharge from the postanesthesia care unit (PACU) was significantly shorter in DP than in DR group (P < 0.001). The bronchoscopist-satisfaction scores were higher for DR than DP (P = 0.036). There were significant differences between the 2 groups in terms of the overall incidence of hypertension, tachycardia, and hypoxemia (P < 0.05).Although underwent longer recovery time and more incidence of rescue scheme, DEX-RF resulted in more stable hemodynamic profiles and bronchoscopist-satisfaction scores, lesser patient movements, and can hence be more effectively used in children undergoing flexible bronchoscopy than dexmedetomidine-propofol.

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“…In spite of three quarters of foreign bodies being removed via a flexible bronchoscope the author still recommend that rigid bronchoscopy is the preferred procedure for the removal of aspirated material; however in cases where foreign body aspiration is part of the differential diagnosis and patients have no history of foreign body aspiration, flexible bronchoscopy is preferred 25 . This study further indicates the necessity of having the skills to perform interventions via the bronchoscope in LMIC, where the skills are sadly lacking and where training is urgently required 26 .…”

Section: Discussionmentioning

confidence: 72%

The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV

Webster

Goussard

Gie

et al. 2017

Expert Review of Respiratory Medicine

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Bronchoscopy is an important investigation in the diagnosis and management of childhood respiratory diseases widely used in high income countries. There is limited information on value of paediatric bronchoscopy in low and middle income countries (LMIC). Aims and Objectives:Aim of this study was to describe the indications, findings and complications of paediatric bronchoscopy in a middle income country with a high prevalence of tuberculosis (TB) and HIV. Methodology:A retrospective analysis of a database which included all bronchoscopies on neonates and children over a 3.5 year period (January 2010 to June 2013) in a tertiary care children's hospital in South Africa. Results and Discussion:A total of 509 bronchoscopies, of which 502 (98%) were fibre-optic bronchoscopies, were performed on neonates (2.3%) and children (median age = 18 months; range 1 day-14.6 years)( (male=58%) of which 5.1% were HIV-infected. The main indications were: large airway compression 40% (n = 204) complicated pneumonia (25 %) and persistent stridor (15 %). Pathology was observed in 64% (n = 319) of bronchoscopes . The most common pathology seen was lymph node compression of the airways (21%), and upper airway pathology (12%). Interventional procedures were performed in 112 cases (22%), the commonest being removing foreign bodies removal (30%), endobronchial lymph node enucleation (30%) and transbronchial needle aspiration (20%). No major complications occurred during or following bronchoscopy. ConclusionThe diagnostic yield of paediatric bronchoscopy did not significantly differ from those reported from high income countries emphasising the importance of paediatric bronchoscopy in the management of childhood lung disease in LMICs.

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The need for bronchoscopic services for children in low and middle-income countries

Cited by 7 publications

References 20 publications

Computed tomography in children with community-acquired pneumonia

Computed tomography in children with community-acquired pneumonia

The efficacy of dexmedetomidine-remifentanil versus dexmedetomidine-propofol in children undergoing flexible bronchoscopy

The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV

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