A nursing perspective on bronchoscopic intervention strategies for children with macrolide-unresponsive Mycoplasma...

Macrolide-unresponsive Mycoplasma pneumoniae pneumonia has evolved from a benign, self-limiting infection into a condition capable of progressing to plastic bronchitis and obliterative bronchiolitis. Current guideline-based strategies remain anchored to a reactive logic of antibiotic switching and deferred intervention, thereby missing a critical therapeutic window before irreversible airway remodeling begins. This perspective article proposes a paradigm shift that reconceptualizes bronchoscopy not as a salvage drainage tool, but as a temporally sensitive vehicle for a triadic strategy of immune modulation, microenvironmental re-equilibration, and structural protection. We delineate a three-dimensional stratified interventional framework comprising: early identification of a golden intervention window informed by biomarkers and imaging; modular, phenotype-guided techniques that prioritize mucosal preservation; and peri-interventional management that couples systemic immunomodulation with respiratory mechanics protection. We further identify key translational bottlenecks, including the absence of standardized protocols, reliance on surrogate endpoints rather than preservation of distal airway function, and unresolved safety boundaries in young children. Addressing these gaps through prospective, evidence-generating research is essential to establish this integrated strategy as the new standard of care.