Application of bronchoscopy in the therapy of pediatric status asthmaticus

Abstract

Objective To explore the therapeutic value of bronchoscopy in pediatric status asthmaticus. Methods A total of 16 children with status asthmaticus received standard medical therapies (therapy group) from January 2008 to August 2010 in pediatric intensive care unit (PICU) at First Hospital, Xiamen University. However, 10 of them underwent fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) (bronchoscopy group) along with standard medical therapies from September 2010 to July 2012. The values of oxygenation index (PaO2/FiO2), arterial partial pressure of carbon dioxide (PaCO2), blood oxygen saturation (SaO2), heart rate (HR), respiratory rate (RR) within 1 hour before bronchoscopy procedure, within 6 hour post procedure and within 24 hour post procedure were observed. The extinction time of wheezing sound, PICU length of stay and admission length of stay were observed between therapy and bronchoscopy groups. Results Bronchoscopies revealed a lot of thick mucus plugs and secretions. Large airways were lavaged for clearance of obstructive secretions with normal saline. Within BAL fluid counts of the bronchoscopy group, there were neutrophilia (n=8), eosinophilia (n=4) and neutrophilia/eosinophilia (n=3). Within BAL fluid cultivation of the bronchoscopy group, 4 patients had positive results for Streptococcus pneumoniae (n=2), Pseudomonas aeruginosa (n=1) and Staphylococcus aureus (n=1). In bronchoscopy group, the values of PaO2/FiO2, PaCO2, SaO2, HR and RR were 319±19,(40±4) mm Hg (1 mm Hg=0.133 kPa), (92.6±1.5)%, (128±12) rates/min and (35±4) breaths/min within 6 hour post procedure versus 255±24, (54±5) mm Hg, (89.2±2.6)%, (148±10) rates/min and (50±6) breaths/min within 1 hour before procedure (P<0.01). At 24 hour post procedure, the values of PaO2/FiO2, PaCO2, SaO2, HR, RR for bronchoscopy group were 354±21,(40±3) mm Hg, (93.4±1.1)%, (125±9) rates/min and (34±3) breaths/min versus 317±21, (46±4) mm Hg, (90.1±2.5)%, (138±8) rates/min and (43±3) breaths/min respectively for therapy group (P<0.01). The extinction time of wheezing sound was (67±22) hours for bronchoscopy group vs. (98±23) hours for therapy group (P<0.01). The mean PICU length of stay was (1.6±0.7) days for bronchoscopy group vs. (2.6±0.7) days for therapy group (P<0.01). The mean admission length of stay was (5.0±0.7) days for bronchoscopy group vs. (6.6±1.2) days for therapy group (P<0.01). All patients for bronchoscopy group tolerated the procedure without any complications. Conclusion As a safe adjunctive therapy in pediatric status asthmaticus, flexible bronchoscopy with bronchial lavage may reduce the admission and PICU length of stay and alleviate clinical symptoms. Key words: Status asthmaticus; Bronchoscopy; Bronchoalveolar lavage