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Updated: Jul 20, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Retrospective evaluation of a paediatric intensivist-led flexible bronchoscopy service
Soumendu S Manna1, Andrew Durward, Shyamala Moganasundram
1Paediatric Intensive Care Unit, Evelina Children's Hospital, Guy's and Saint Thomas' NHS Trust, London, UK.
Insights
Flexible bronchoscopy in critically ill children offers high diagnostic yield, especially for airway issues and extubation failure. This intensifier-led service in the pediatric intensive care unit (PICU) demonstrates significant clinical benefit.
Area of Science:
- Pediatric Critical Care Medicine
- Pulmonology
- Interventional Procedures
Background:
- Critically ill children often present with complex respiratory conditions requiring advanced diagnostic tools.
- Flexible bronchoscopy is a valuable tool, but its role in pediatric intensive care units (PICUs) led by intensivists needs further evaluation.
- Understanding the diagnostic yield and therapeutic impact is crucial for optimizing patient management.
Purpose of the Study:
- To assess the diagnostic yield of flexible bronchoscopy performed by intensivists in critically ill children.
- To evaluate the therapeutic role and safety of this procedure within a PICU setting.
- To determine the overall effectiveness of an intensivist-led bronchoscopy service.
Main Methods:
- Retrospective chart review of 134 critically ill children undergoing 148 flexible bronchoscopies over 2.5 years.
- Procedures were performed by intensivists in a regional pediatric intensive care unit.
- Indications included suspected upper/lower airway disease, pulmonary disease investigation, and extubation failure.
Main Results:
- A positive diagnostic yield was observed in 76% of procedures, with higher rates for upper airway disease (90%) and extubation failure (90%).
- The majority of patients (88%) required mechanical ventilation, and 22% were on inotropes.
- Procedure-related adverse events included transient oxygen desaturation (10%) and hypotension requiring fluid resuscitation (17%).
Conclusions:
- An intensivist-led flexible bronchoscopy service in the PICU provides a high diagnostic yield for critically ill children with respiratory problems.
- The procedure is particularly beneficial for diagnosing upper airway conditions and managing extubation failure.
- This service demonstrates a valuable therapeutic role and acceptable safety profile in this vulnerable patient population.
Objective:
To demonstrate the diagnostic yield, therapeutic role and safety of flexible bronchoscopy via an intensivist-led service in critically ill children.
Design:
Retrospective chart review.
Setting:
Regional paediatric intensive care unit.
Measurements And Results:
One hundred forty-eight flexible bronchoscopies were performed by two intensivists on 134 patients (median age 16.5 months) over a 2.5-year period. Eighty-eight percent of patients required mechanical ventilation, and 22% were receiving inotropes. Case mix included general (n = 77), cardiac surgery (n = 18), cardiology (n = 13), ear-nose-and-throat surgery (n = 17), oncology (n = 8) and renal (n = 1). The indication for bronchoscopy was defined a priori according to one of four categories: suspected upper airway disease (n = 32); lower airway disease (n = 70); investigation of pulmonary disease (n = 25); and extubation failure (n = 21). Bronchoscopy was generally performed soon after PICU admission, at a median time of 1.5 days for the former three categories, and 4 days for extubation failure group. A positive yield from bronchoscopy (diagnosis that explained the clinical condition or influenced patient management) was present in 113 of 148 (76%) procedures, varying within groups from 44% (pulmonary disease) to 90% (extubation failure). Ten percent of patients developed a fall in oxygen saturations > 20% during the procedure and 17% required a bolus of at least 10 ml/kg of 0.9% saline for hypotension.
Conclusions:
Critically ill patients with respiratory problems may benefit from a PICU-led bronchoscopy service as the yield for positive bronchoscopic finding is high, particularly for upper airway problems or extubation failure.
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