Therapeutic airway procedures during flexible bronchoscopy in infants and children

Abstract

Background: Flexible bronchoscopy is increasingly used as a therapeutic tool in small children with significant airway pathology. Aim: To assess the characteristics of patients and airway procedures performed during flexible bronchoscopy at a single pediatric bronchoscopy center in a 5-year period. Methods: Procedure protocols, video documentation and corresponding patient charts from the period 2010-2014 at the University Children9s Hospital Ljubljana were analyzed. Results: A total of 490 flexible bronchoscopies were performed in the observed period. Therapeutic airway procedures were carried out 55 times in 37 patients (median age 2.8 yrs, range 0.1-17.0 yrs, 54 % girls). Procedures performed: 39 large mucous plugs and bronchial casts removals, 9 foreign body extractions, 7 other airway occlusion resolutions (1 large laryngeal granulation, 2 subglottic membranes, 1 tracheal membrane, 3 bronchial membranes). The children in the third group were significantly younger (0.6±0.9 vs. 6.5±6.0 yrs, p=0.014). Bronchoscopies were performed in the endoscopy suite, except for: tracheal membrane (baby in the incubator), laryngeal granulation and subglottic membranes (operating room, ENT surgeon, thoracic surgeon present). Procedures were performed under general anesthesia, using facial mask, with spontaneous breathing preserved. Bronchoscopes size 2.8, 3.8 and 4.9 mm, bronchial balloons, Fogarty catheters and biopsy forceps were used. No patient suffered significant complications, none was intubated after the procedure. Conclusions: In appropriate settings, flexible bronchoscopy allows for safe and less invasive treatment of significant airway pathology in infants and small children.