Pulmonary diagnostic procedures: Bronchoscopy

Abstract

Bronchoscopy is currently the most commonly employed invasive procedure in the practice of pulmonary medicine. Both the rigid and flexible bronchoscopes are used to diagnose and treat various pulmonary disorders, in children the main diagnostic indications include infections, diffuse lung diseases, and airway problems. The bronchoscope is used too in application of laser therapy, placement of airway stents, and balloon dilatation to relieve airway obstruction caused by malignant and benign airway lesions. Today pediatric flexible fiberoptic bronchoscopy (FFB) is a safe diagnostic and interventional tool, even in young or extremely premature infants. Recent series explore newer applications, delineate potential complications, and make recommendations for its future application. The technique and clinical application of bronchoscopy had their origins in 1897, when Gustav Killian used a rigid endoscope to examine the airways. Chevalier Jackson refined the rigid bronchoscope, which was the only type of instrument available for the evaluation of airways until the early 1970s, when Shigeto Ikeda developed the flexible fiberoptic bronchoscope. Flexible airway endoscopy has been used in clinical and research investigations of pediatric airway and pulmonary disorders for nearly 25 years. Not only has clinical use of the flexible bronchoscope improved our evaluation and management of a variety of airway and pulmonary diseases in children, but also research investigations using lavage and biopsy specimens obtained with the flexible bronchoscope have contributed extensively to our understanding of lung inflammation and infection. Improvements and new developments in fiberoptic endoscope technology, training of airway endoscopists, preoperative and sedative medications, patient monitoring, and airway endoscopic techniques, as well as adjunctive minimally invasive and noninvasive diagnostic modalities, continue to refine and enhance the pediatric clinical and research applications of flexible airway endoscopy. One of the fhaters of pediatrics bronchoscopy is Robert E Wood who stablish -1980sthat flexible bronchoscopy, with appropriate instrumentation and careful attention to physiological requirements of the patient, is safe and effective in pediatric patients. Over 1000 procedures an endoscopic diagnosis of direct relevance to the primary indication was established in 76% of the cases. The bronchoscope was most useful in the evaluation of patients who had stridor, atelectasis, persistent wheezing, or a suspected foreign body, and for patients who had tracheostomies. The high diagnostic yield and low complication rate strongly support the use of the flexible bronchoscope in the diagnostic evaluation of infants and children who have a variety of pulmonary problems. At the end of 1990s a colaborative study of ERS suggest that bronchoscopy in children was a wellestablished procedure at several European centres, while others are just beginning to use this technique. Fifty one European centres took part in the study. Discusion about sedation type are continued. Diagnostic BAL or extraction of mucous plugs should be accomplished with optimal control of the airway under general anesthesia. The use of the laryngeal mask airway (LMA) during flexible fiberoptic bronchoscopy is safe, provides excellent patient comfort, and should be utilized as an alternative to endotracheal intubation.