Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: A systematic review

Abstract

AIM:To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to flexible fiberoptic bronchoscopy (FFB) in critically ill children. METHODS:We searched PubMed, SCOPUS, OVID, and EMBASE databases through July 2014 for English language publications studying FFB performed in the intensive care unit in children < 18 years old. We identified 666 studies, of which 89 full-text studies were screened for further review. Two reviewers independently determined that 27 of these studies met inclusion criteria and extracted data. We examined the diagnostic yield of FFB among upper and lower airway evaluations, as well as the utility of bronchoalveolar lavage (BAL). RESULTS:We found that FFB led to a change in medical management in 28.9% (range 21.9%-69.2%) of critically ill children. The diagnostic yield of FFB was 82% (range 45.2%-100%). Infectious organisms were identified in 25.7% (17.6%-75%) of BALs performed, resulting in a change of antimicrobial management in 19.1% (range: 12.2%-75%). FFB successfully reexpanded atelectasis or removed mucus plugs in 60.3% (range: 23.8%-100%) of patients with atelectasis. Adverse events were reported in 12.9% (range: 0.5%-71.4%) of patients. The most common adverse effects of FFB were transient hypotension, hypoxia and/ or bradycardia that resolved with minimal intervention, such as oxygen supplementation or removal of the bronchoscope. Serious adverse events were uncommon; 2.1% of adverse events required intervention such as bag-mask ventilation or intubation and atropine for hypoxia and bradycardia, normal saline boluses for hypotension, or lavage and suctioning for hemorrhage. CONCLUSION:FFB is safe and effective for diagnostic and therapeutic use in critically ill pediatric patients.

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

“…These TFAE techniques may not be applicable to very small children because of their narrower airways, poor physiologic reserve, higher sedative risk, and different pulmonary disease entities. The recently reported TFAE [ 8 – 11 ] also rarely discussed the more challenging fields of laser therapy, balloon dilatation plasty (BDP), metallic (balloon expandable) stent implantation and stent plasty. Theoretically, effective TFAE can prevent more invasive interventions of rigid endoscopy (RE) [ 7 ] or surgeries such as tracheostomy, laryngotracheal reconstruction, tracheobronchial (TB) plasty, all of which need general anesthesia or even extracorporeal life support (ECLS) [ 8 – 13 ].…”

ERS statement: interventional bronchoscopy in children

“…Flexible bronchoscopic intubation represents the most frequent primary indication for interventional bronchoscopy in paediatric intensive care patients [145,146], particularly for critically ill [147] and syndromic [148] patients. In children nasal intubation tends to be easier than oral intubation, because the angle around the base of the tongue is less sharp than in adults.…”

Pediatric Flexible Bronchoscopy Under Conscious Sedation in an Endoscopy Suite – Is It Feasible, Safe and Yielding?: An Observational Study

“…3,4 Studies report close to 80% diagnostic and about 60% therapeutic yield in pediatric fibre-optic bronchoscopy. 5 A substantial number of them also include evaluation of a suspected foreign body and structural malformation. 6 In our experience the combined diagnostic and therapeutic yield was more than 90%.…”