Trade-off between airway resistance and optical resolution in pediatric rigid bronchoscopy

Contemporary pediatric rigid bronchoscopy reflects the culmination of years of work by prominent endoscopists aided by technical developments in optical physics and refinements in optical lens manufacturing. Improved neonatal and pediatric care has allowed survival of premature infants, many with bronchopulmonary diseases. Rigid bronchoscopy in these infants is demanding and has necessitated the development of miniaturized telescopic bronchoscopes. This study documents airway pressures through bronchoscopes with and without endoscopic telescopes, analyzes and quantitates optical resolution, discusses the trade-offs between these instruments in airway resistance and optical resolution, and makes recommendations regarding which combinations of endoscopes and bronchoscopes provide the best resistance and resolution profiles. We conclude that the size 1.9-mm endoscopic telescope provides the most favorable resistance and resolution profile for the size 2.5 to 3.0 bronchoscopes, the 2.8-mm telescope is ideal for the 3.5 bronchoscope, and the 4.0-mm telescope works best with the 4.0 and larger bronchoscopes. Furthermore, optical forceps and side-channel forceps used during bronchial foreign body removal cause little change in airway resistance.