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Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Pediatric fiberoptic bronchoscopy as adjunctive therapy in acute asthma with respiratory failure
J Carlos Maggi1, Eliezer Nussbaum, Christopher Babbitt
1Miller Children's Hospital, Long Beach, CA, USA.
Insights
Flexible bronchoscopy safely clears mucus in pediatric respiratory failure, reducing mechanical ventilation and ICU stays. This adjunctive therapy offers significant benefits for asthmatic patients needing airway clearance.
Area of Science:
- Pediatric Intensive Care
- Pulmonary Medicine
- Critical Care
Background:
- Status asthmaticus respiratory failure involves thickened mucus requiring aggressive pulmonary clearance.
- The utility of bronchoscopy in pediatric mechanically ventilated asthmatic patients remains under-explored.
Purpose of the Study:
- To evaluate the safety and efficacy of flexible bronchoscopy as an adjunctive therapy for pediatric patients with status asthmaticus and respiratory failure.
Main Methods:
- A retrospective chart review identified 44 pediatric intensive care unit patients with respiratory failure due to status asthmaticus over 13 years.
- Twenty-nine patients received flexible bronchoscopy with bronchial lavage for mucus plugs, atelectasis, or obstruction; 15 did not.
- Outcomes were compared between the bronchoscopy and control groups.
Main Results:
- Bronchoscopy effectively removed thick mucus plugs and bronchial casts, improving pulmonary compliance without complications.
- The median intubation time was significantly shorter in the bronchoscopy group (10 hr vs. 20.5 hr).
- The mean intensive care unit length of stay was reduced in the bronchoscopy group (3.06 days vs. 3.4 days).
Conclusions:
- Flexible bronchoscopy with bronchial lavage is a safe adjunctive therapy for pediatric asthmatic respiratory failure.
- This intervention can reduce mechanical ventilation duration and intensive care unit length of stay.
- Further studies are needed to establish bronchoscopy as a standard treatment for pediatric asthmatic respiratory failure.
Background:
Status asthmaticus respiratory failure is associated with thickened mucus secretions necessitating aggressive pulmonary clearance. The role of bronchoscopy in pediatric mechanically ventilated asthmatic patients has not been published.
Methods:
A chart review was performed on all pediatric intensive care unit (PICU) asthmatics with respiratory failure over 13 years. Forty-four patients were identified. Patients were managed per standardized guidelines for status asthmaticus with mechanical ventilation. Ventilator management prioritized spontaneous breathing with pressure support. Extubation criteria included spontaneous tidal volumes of 5-7 cm(3) /kg on low-pressure support. Standard endotracheal tube pulmonary toilet were implemented. Twenty-nine patients underwent bronchoscopy as an adjunctive therapy. Indications for bronchoscopy included: Pathogen identification via bronchoalveolar ravage, atelectasis, mucus obstruction resulting in severe air trapping, suspected aspiration, and poor response to standard therapy. Clinical outcomes of this intervention were compared to the fifteen patient cohort who did not undergo bronchoscopy.
Results:
Bronchoscopies revealed thick mucus plugs, secretions, and bronchial casts. The large airways were lavaged for clearance of obstructive secretions with normal saline. All patients tolerated the procedure without any complications. Demonstrable improvement in pulmonary compliance was noted. The median time of intubation for the bronchoscopy group was 10 hr compared to 20.5 hr for the control group (P < 0.0005). The mean intensive care unit length of stay was 3.06 days for the bronchoscopy group versus 3.4 days for the non-bronchoscopy group (P < 0.05).
Conclusion:
Flexible bronchoscopy with bronchial lavage is a safe adjunctive therapy in pediatric asthmatics with respiratory failure resulting in reduced mechanical ventilation and intensive care length of stay. Restoring lung volume in certain asthmatics during respiratory failure may be deemed beneficial. Further validated studies are necessary to recommend bronchoscopy to the present, accepted treatment regimen in pediatric asthmatic respiratory failure.
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