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[Value of fiberoptic bronchoscope in children with epiglottitis]
J P Monrigal1, J C Granry, C Jeudy
1Unité d'Anesthésie et de Réanimation Polyvalente de l'Enfant, CHU, Angers.
Insights
Fiberoptic bronchoscopy aids in diagnosing and managing acute epiglottitis in children. This minimally invasive technique facilitates endotracheal intubation and extubation decisions, improving patient outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Otolaryngology
- Respiratory Medicine
Background:
- Acute epiglottitis presents a critical risk of respiratory distress and potential cardiac arrest in children.
- Traditional diagnostic and management approaches carry significant risks due to the sensitive nature of the condition.
Observation:
- Fiberoptic bronchoscopy allows for direct visualization of the epiglottis in children with acute epiglottitis.
- The procedure is performed with the child in a sitting position under local anesthesia, with oxygen delivered via nasal tube.
Findings:
- Fiberoptic bronchoscopy enables rapid and accurate diagnosis of epiglottitis by direct visualization.
- The technique facilitates endotracheal intubation by allowing spontaneous breathing and using expiratory airflow to guide the bronchoscope.
- It also aids in determining the optimal timing for extubation.
Implications:
- This minimally invasive approach reduces the risk of stimulation and positional changes, enhancing patient safety.
- Fiberoptic bronchoscopy streamlines the management of acute epiglottitis, potentially improving clinical outcomes in pediatric patients.
- The use of a bronchoscope as a guide simplifies endotracheal intubation, especially in cases requiring smaller tubes.
Abstract:
Acute epiglottitis is an infectious disease causing a severe respiratory distress. Any attempt to move the child in the horizontal position or to examine his throat can result in cardiac arrest. Diagnosis, endotracheal intubation as well as decision making of the optimal time for extubation are greatly facilitated by the use of a fiberoptic bronchoscope. The device is a paediatric model (external diameter 3.6 mm with an operating channel). It is inserted through the nare in the child in the sitting position. Oxygen is delivered through a nasal tube. The examination is performed under local anaesthesia (lidocaine 0.5%). Midazolam is sometimes added via the rectal or i.v. route. The clinical signs are monitored as well as the heart rate and SpO2. The diagnosis of epiglottitis as it is visual, is very easy and rapid once the epiglottis is observed through the fibreoptic bronchoscope. The advantage of the examination under fibreoptic bronchoscope is to allow visualization without aggression or stimulation of the pharyngolaryngeal structures and without modification of the child's position. Endotracheal intubation, which is always required, is facilitated as the child is breathing spontaneously. The expiratory flow blows bubbles of saliva, which guide the bronchoscope to the glottis. When the internal diameter of the endotracheal tube is larger than 4 mm, the bronchoscope is used as a guide. When it is less than 4 mm. the bronchoscope is inserted in the trachea with a guide wire slipped in the operating channel; the bronchoscope, but not the wire is withdrawn and the endotracheal tube is inserted over the guide wire.(ABSTRACT TRUNCATED AT 250 WORDS)