Flexible bronchoscopy in pediatric intensive care

To define the benefits of a flexible bronchoscopy (FB) service in a Paediatric Intensive Care Unit (PICU).

Review of the first 200 FBs undertaken in a large PICU.

Large cardiac and medical PICU in the United Kingdom, also providing extra-corporeal life support.

129 patients (78 males, 51 females, median age 9.9 months, median weight 4.6 kg) underwent FB from August 1990 to June 2003.

Broncho-alveolar lavage (BAL) as indicated at time of bronchoscopy.

Basic patient parameters were identified, including ventilation modes and diagnoses. FB findings were correlated with microbiology results.

The majority of the FBs were diagnostic (161 of 200). 114 of these were undertaken to exclude underlying airway abnormalities and 47 to aid the diagnosis of pneumonia. Therapeutic procedures including bronchial stenting, directed surfactant instillation and broncho-alveolar toileting were undertaken in 39 cases. 68% of the diagnostic FBs were deemed to be abnormal. 16% had significant extra-luminal airway obstruction. 24% had new findings of airway anomalies. 14.5% of the FBs showed endo-tracheal tube misplacement. Positive microbiological results which altered or confirmed changes in patient management occurred in 46.1% children who had BAL specimens cultured. 80 of the FBs were undertaken whilst the children were receiving extra-corporeal life support. Only one FB procedure was ceased because of patient instability.

There is a high yield of positive findings from undertaking FB both anatomically and microbiologically. FB should be seen as a routine diagnostic and therapeutic tool in paediatric intensive care.