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Updated: Jun 22, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Flexible fibreoptic bronchoscopy is beneficial in children on extracorporeal membrane oxygenation support
Pravin Babhalgaonkar1, Gareth Forster2, Ian B Masters3
1Paediatric Intensive Care Unit, Sydney Children's Hospital, Sydney, Australia.
Insights
Flexible fibreoptic bronchoscopy (FFB) aids children on extracorporeal membrane oxygenation (ECMO) by improving diagnostics and airway clearance. This procedure offers clinical benefits with a low rate of major complications, enhancing care for severe respiratory failure.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Interventional Pulmonology
Background:
- Flexible fibreoptic bronchoscopy (FFB) shows promise in enhancing diagnostic capabilities and improving pulmonary function in pediatric patients requiring extracorporeal membrane oxygenation (ECMO).
- ECMO support is critical for children with severe respiratory failure, necessitating advanced monitoring and intervention techniques.
Purpose of the Study:
- To evaluate the clinical, radiological, and microbiological benefits of performing FFB in children supported by ECMO.
- To assess the safety and complication rates associated with FFB in this vulnerable pediatric population.
Main Methods:
- A single-centre retrospective observational cohort study was conducted.
- Included were all FFB procedures performed on pediatric patients (0-18 years) receiving ECMO during the study period.
- Data collected included clinical outcomes, radiological findings, microbiological results, and complication incidence.
Main Results:
- FFB provided diagnostic information in 53% of cases and aided airway clearance in 62% of episodes.
- Patients showed improved oxygenation post-FFB, with lower fraction of inspired oxygen at 6 and 24 hours.
- Radiological findings improved or remained stable in 91% of procedures, and FFB identified new microbiological data in 75% of patients. Major complications occurred in 7.6% of episodes.
Conclusions:
- Flexible fibreoptic bronchoscopy is a valuable adjunctive tool for managing pediatric patients on ECMO, offering significant clinical advantages.
- The procedure is associated with a low incidence of major complications, making it a relatively safe intervention.
- Further research is recommended to establish consensus guidelines for FFB use in ECMO patients.
Background:
Flexible fibreoptic bronchoscopy (FFB) has the potential to enhance diagnostic capabilities and improve pulmonary function in children on extracorporeal membrane oxygenation (ECMO).
Objectives:
The objective of this study was to evaluate the benefits (clinical, radiological, and microbiological) of FFB and assess associated complications in children on ECMO.
Methods:
We conducted a single-centre retrospective observational cohort study in a tertiary paediatric intensive care unit. All FFB episodes performed during the study period on children aged 0-18 years on ECMO were included.
Results:
Out of the 155 children who received ECMO, 36 (23%) underwent a total of 92 episodes of FFB. FFB provided anatomical and pathological information in 53% (19/36) of cases and proved beneficial in clearing the airways in 62% (54/87) of the episodes. Overall, patients exhibited transient increases in ECMO and mechanical ventilation support 1 h post FFB in 14% (13/92) and 9.7% (9/92) episodes, respectively. At 6 h, the mean fraction of inspired oxygen on the mechanical ventilator was lower (0.46 [±0.21] vs 0.53 [±0.21] p < 0.01), with no change in mean airway pressure. Similarly, compared to pre-FFB, the fraction of inspired oxygen on the mechanical ventilator on ECMO was lower at 6 h and 24 h (0.65 [±0.25] vs 0.71 [±0.23] p < 0.01 and 0.006, respectively), with no significant change in the sweep gas flow and ECMO flow. The radiological imaging indicated improved or stable findings in 91% (83/91) of FFB episodes. FFB contributed to the identification of new and previously unknown microbiological information in 75% (27/36) of the patients. The incidence of major complications was 7.6%. Minor self-resolving bleeding occurred in 25% (23/92) episodes, and major bleeding occurred in two episodes, with a total of 10 episodes needing blood product transfusion.
Conclusions:
FFB is a valuable adjunct in managing children with severe respiratory failure on ECMO, offering clinical benefits with a low rate of major complications. Further studies should aim to develop a consensus approach encompassing criteria and clinical management around FFB in patients on ECMO.
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