Timing of bronchoscopy and application of scoring tools in children with severe pneumonia

Abstract

Background There is still a lack of effective scoring criteria for assessing the severity of pulmonary infection associated with changes in the endobronchial lining of the bronchus in children. This study aimed to ascertain the timing and value of endoscopic scoring of fibreoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in children with severe pneumonia. Method The clinical data of 229 children with severe pneumonia treated with BAL in the Pediatric Intensive Care Unit of the First Affiliated Hospital of Xinxiang Medical University between November 2018 and December 2021 were collected. According to the severity of the disease, patients were divided into an invasive ventilation group and a non-invasive ventilation group, as well as an early BAL group (receiving BAL within 1 day of admission) and a late BAL group (receiving BAL 2 days after admission). A Student’s t-test, Chi-square test, receiver operating characteristic (ROC) curve and survival curve were used to analyse the bronchitis score, aetiology of BAL fluid and survival data. Results The scores of endoscopic mucosal oedema, erythema and pallor and the total score in the invasive ventilation group were higher than those in the non-invasive ventilation group (P < 0.05), and they were consistent with the Sequential Organ Failure Assessment (SOFA) scores. The secretion colour score was lower in the early BAL group than in the late BAL group (P < 0.05). On the bronchitis scores, which were evaluated using a ROC curve, the difference in the mucosal erythema, pallor, oedema and total score of the invasive and non-invasive groups was statistically significant (P < 0.05), which was consistent with the area under the ROC of the SOFA scores. Acute Physiology and Chronic Health Assessment II and SOFA scores after FOB were lower than those before treatment (P < 0.05). In terms of ICU hospitalisation days and total hospitalisation days, the time of the early FOB patients was shorter than that of the late FOB patients (P < 0.05). A total of 22 patients (9.61%) died. The Kaplan–Meier analysis and log-rank test showed that the survival rate of the non-invasive ventilation group was higher than that of the invasive ventilation group (P < 0.05). Conclusion This study found that FOB combined with BAL is an important method for the diagnosis and treatment of severe pneumonia. Early BAL can reduce hospitalisation and ICU time; however, it cannot improve the survival rate. The endoscopic score has a certain role to play in assessing the severity of pulmonary inflammation, but studies with a large sample are still needed to confirm this.

Predictive value of bronchoscopy combined with CT score for refractory mycoplasma pneumoniae pneumonia in children

“…Mycoplasma pneumoniae pneumonia (MPP) is notably prevalent in paediatric wards, accounting for approximately 10–40% of paediatric community-acquired pneumonia pathogens [ 1 ]. This condition can cause not only respiratory tract infections but also lead to extrapulmonary manifestations, such as myocardial damage, Stevens–Johnson syndrome, encephalitis, and liver damage [ 2 , 3 ].…”

Brochoscopic Airway Clearance Therapy vs. Conventional Sputum Aspiration: The Future of Flexible Brochoscopes in Intensive Care Units?

“…A retrospective cohort study found that the in-ICU mortality and 90-day mortality in the early bronchoscopy group (bronchoscopy within 24 h after intubation) were significantly lower than those in the late bronchoscopy group (in-ICU: 4.9% vs. 24.6%; 90-day: 11.8 vs. 32.8%), and was associated with lower 90-day mortality in multivariate analysis (HR:0.412, 95% CI: 0.192-0.883, p = 0.023), indicating that early bronchoscopy benefits the clinical outcome of mechanically ventilated patients with SP [20]. However, another retrospective observational study divided 229 SP children into the IMV group and non-IMV group, as well as the early BAL group (receiving BAL within 1 day of admission) and late BAL group, and found that early BAL under bronchoscopy could not improve the survival rate but can reduce the hospitalization and ICU time, exhibiting that B-ACT is still beneficial to the prognosis of SP patients [21]. Therefore, it is still necessary to have further prospective research to explore the appropriate number, time or frequency of B-ACT for SP patients undergoing IMV, knowing that more accurate, individualized and comprehensive airway clearance management is urgently required in such patients.…”

Optimization strategy for the early timing of bronchoalveolar lavage treatment for children with severe mycoplasma pneumoniae pneumonia

“…We showed that patients with high CT scores in the upper left lobe were more likely to develop SMPP, which may be related to the high anatomical position and the smaller and more numerous bronchial subsegment openings, which can affect the spread and resolution of lobar pneumonia [ 21 ]. BS is a quantitative assessment of bronchial inflammation by bronchoscopy [ 9 ], which can directly evaluate bronchial wall destruction and endobronchial sputum blockage. Many children with MP-induced atelectasis or consolidation had a large amount of secretion in the bronchus, and may only display endometrial pale or erythema.…”

“…Our previous study showed that early BAL could reduce hospitalization and ICU time [ 9 ]. Previous studies have shown that BAL can effectively treat children with refractory MPP or MPP complicated with atelectasis and reduce cytokines [ 8 , 10 , 25 ].…”

“…Few studies have investigated the effectiveness of BAL treatment for children with SMPP. The early therapeutic BAL(TBAL)treatment (receiving BAL within 1 day of admission) was considered to be beneficial for patients with severe pneumonia by reducing the hospitalization time [ 9 ]. The lack of standardized criteria and definitions for SMPP and the potential risks and complications of BAL make it difficult to compare the results across studies, which may outweigh the benefits in some cases [ 10 ].…”