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Published on: June 23, 2023
Retrospective Review of Flexible Bronchoscopy in Pediatric Cancer Patients
Ali H Ahmad1, Brandon D Brown2, Clark R Andersen3
1Pediatric Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Insights
Flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) is safe for pediatric cancer patients. This procedure aids in diagnosing pulmonary complications and guides antimicrobial treatment decisions.
Area of Science:
- Pediatric Oncology
- Pulmonology
- Infectious Diseases
Background:
- Flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) is a standard diagnostic tool for pulmonary complications in adults.
- Its safety and efficacy in pediatric cancer patients remain less understood.
Purpose of the Study:
- To evaluate the safety and outcomes of FB with BAL in pediatric cancer patients.
- To identify patient groups who may benefit most from this procedure.
Main Methods:
- Retrospective review of FB procedures performed between 2002 and 2017.
- Analysis of patients under 21 years old diagnosed with cancer.
Main Results:
- FB with BAL was found to be safe in this pediatric population.
- Increased fluid volume during BAL correlated with higher rates of positive bacterial and viral cultures.
- Findings from FB led to changes in antimicrobial therapy in over half of the cases.
Conclusions:
- Flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) is a safe and beneficial procedure for pediatric cancer patients.
- The findings support the use of FB in managing pulmonary complications and guiding treatment decisions in this vulnerable population.
Abstract:
The use of flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) to diagnose and manage pulmonary complications has been shown to be safe in adult cancer patients, but whether its use is safe in pediatric cancer patients remains unclear. Thus, to describe the landscape of FB outcomes in pediatric cancer patients and to help define the populations most likely to benefit from the procedure, we undertook a retrospective review of FBs performed in patients younger than 21 years treated at our institution from 2002 to 2017. We found that a greater volume of total fluid instilled during BAL was significantly associated with increased probabilities of positive BAL culture (p=0.042), positive bacterial BAL culture (p=0.037), and positive viral BAL culture (p=0.0496). In more than half of the FB cases, findings resulted in alterations in antimicrobial treatment. Our study suggests that for pediatric cancer patients, FB is safe, likely provides diagnostic and/or therapeutic benefits, and has implications for treatment decisions.
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