Flexible Bronchoscopy in Pediatric Patients with Chronic Respiratory Insufficiency and Artificial Airways

Abstract

Flexible bronchoscopy (FFB) is a well-established diagnostic and therapeutic tool in pediatric pulmonology. From January 1990 through June 1998, our division performed 574 FFBs. We developed a database for 457 of these procedures (77%) and reviewed it to determine the indications, benefits, and complications of pediatric bronchoscopy. Patient age ranged from 1 to 248 months (median age, 54 months). Common preoperative diagnoses included traumatic brain injury with artificial airways (21.4%), bronchopulmonary dysplasia (12.3%), cerebral palsy (11.8%), underlying neuromuscular disorder (8.8%), tracheostomy and tracheomalacia (22.4%), pneumonia (6.1%), removal of foreign body (4.6%), asthma (8.5%), and cystic fibrosis (1.5%). A total of 78.6% of patients had tracheostomy tubes; 65.4% were mechanically ventilated. Procedures were emergent in 6% of patients, semiemergent in 51% of patients, and routine in 43% of patients. In patients with chronic respiratory failure and artificial airways, mean time between bronchoscopies was 13.5 months. FFB was performed in a bronchoscopy suite in 72% of procedures, in an operating room in 24%, and at the bedside (intensive care unit) in 2.8%. Laryngomalacia, tracheomalacia, and/or bronchomalacia were present in 20.4% of patients, and 9.8% had subglottic stenosis. Other common postoperative diagnoses included suprastomal granuloma at the proximal end of the tracheostomy tube, tracheitis (30.2%), bronchitis (10.7%), suction trauma (5.3%), and/or pneumonia (7.2%). Changes in management resulting from FFB findings included tracheal decannulation (9.4%), change in antibiotic therapy (22.5%), change in continuous positive airway pressure (7.2%), change in tracheostomy tube size (23.2%), and alteration in suction technique (5.3%). A total of 9.2% of patients required surgical intervention, and most of these procedures were for removal of suprastomal granuloma before anticipated decannulation. Complications were rare and included over- and undersedation (0.7%), and fever (2.8%). No life-threatening events occurred, including pneumothorax or hemorrhage. Pediatric FFB is a safe and useful tool in the management of patients with chronic respiratory insufficiency and artificial airways. Journal of Bronchology7:306-310, 2000. FFB, flexible bronchoscopy; APN, advanced practice nurse; PEEP, positive end-expiratory pressure; CPAP, continuous positive airway pressure.