Therapeutic flexible airway endoscopy of small children in a tertiary referral center—11 years’ experience

Abstract

ObjectivesUse of therapeutic flexible airway endoscopy (TFAE) is very limited in pediatrics. We report our clinical experiences and long term outcomes of TFAE in small children from a single tertiary referral center.MethodsThis is a retrospective cohort study. Small children with their body weight no more than 5.0 kg who had received TFAE between 2005 and 2015 were enrolled. Demographic information and outcomes were reviewed and analyzed from medical charts and TFAE videos.ResultsA total of 313 TFAE were performed in 225 children. The mean age was 3.50 ± 0.24 (0.01–19.2) months old; the mean body weight was 3.52 ± 0.65 (0.57–5.0) kg. A noninvasive ventilation technique, without mask or artificial airway, was applied to support all the procedures. TFAE included laser therapy (39.6%), balloon dilatation plasty (25.6%), tracheal intubation (24.3%) and metallic stent placement (6.4%). Short-length endoscopes of 30–35 cm were used in 96%. All TFAE were successfully completed without serious adverse events or mortality. Mean procedural time was 27.6 ± 16.1 minutes. TFAE resulted in successful extubation immediately in 67.2% (45/67) and 62.8% (118/188) were able to wean off their positive pressure ventilation support in 7 days after procedures. By the end of this study, these TFAE averted the originally suggested airway surgeries in 93.8% (61/65), as benefited from laser therapy, stent implantation, and balloon dilatation plasty.ConclusionsThe TFAE modality of using short-length endoscopes as supported with this noninvasive ventilation and ICU support is a viable, instant and effective management in small children. It has resulted in rapid weaning of respiratory supports and averted more invasive rigid endoscopy or airway surgeries.

Proceduralist Given Sedation is Safe and Feasible in Pediatric Flexible Bronchoscopy

“…Over the past decade, the field of interventional pulmonology using flexible bronchoscope is rapidly expanding. 3 With more complex and longer procedures, procedural sedation and analgesia have taken a center stage in contemporary bronchology. 12 Sedation reduces the state of consciousness, while analgesia brings down pain perception.…”

“…Many therapeutic interventions such as the removal of foreign bodies, placement of stents, balloon dilatation of stenotic segments, intrabronchial instillation of glue, and removal of mucus plugs are now routinely being done with the help of flexible bronchoscopy in the pediatric population. 2,3 Whereas in adult bronchoscopy, sedation has a controversial role, 4 its usefulness in children is well accepted. 5,6 The aim of sedation is to facilitate the safe and successful performance of the procedure, as well as to minimize complications, and decrease the pain and anxiety associated with the said procedure.…”

Flexible endoscopy for pediatric tracheobronchial metallic stent placement, maintenance and long-term outcomes

“…Major stent-associated problems included obstructive granulation formation, lumen narrowing at the stent ends, infection, stent distortion and fracture. In addition to the medical management, mechanical interventions were performed by TFE with forceps debridement, laser ablation and BDP [ 12 , 15 – 21 ]. Forceps debridement and laser (Diode, Dornier MedTech®) ablation could remove granulation tissues ( Fig 5 ).…”

“…It is a retrospective study from a single institution with no control group for comparison. Detailed description on the techniques of TFE and NIV of TB BEMS placement and subsequent management such as laser ablation, BDP and stent retrieval are beyond the theme of this study, but they were discussed in our previous published papers [ 15 – 21 ].…”

Sustained pharyngeal inflation with oxygen tube effects on upper airway pressure and lumen changes in infants---flexible bronchoscopy measurement

“…Which has already demonstrated able to provides adequate oxygenation and ventilation to assist interventional flexible bronchoscopy (FB) in children, even in severe asphyxiated status. [9][10][11][12][13][14][15] In the setting of PhO 2 , the ventilation effect of the "nose-close (NC)" can also create PIP in the PLS. A prolonged duration of the NC indeed provides a SPI.…”