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Flexible fiberoptic bronchoscopy in children on extracorporeal membrane oxygenation
K H Karlson1, C B Pickert, S M Schexnayder
1Section of Pulmonology, University of Arkansas for Medical Sciences, Little Rock.
Insights
Flexible fiberoptic bronchoscopy (FFB) with bronchial washings (BW) and bronchoalveolar lavage (BAL) is safe for children on extracorporeal membrane oxygenation (ECMO). This procedure showed no bleeding complications and offered potential benefits for specific pediatric patients.
Area of Science:
- Pediatric Critical Care Medicine
- Pulmonology
Background:
- Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-support measure for critically ill children.
- Bleeding is a significant complication associated with VA-ECMO and flexible fiberoptic bronchoscopy (FFB).
Purpose of the Study:
- To evaluate the safety and potential benefits of performing FFB with bronchial washings (BW) and bronchoalveolar lavage (BAL) in pediatric patients supported by VA-ECMO.
Main Methods:
- Retrospective review of 14 pediatric patients undergoing 19 FFB procedures with BW/BAL while on VA-ECMO.
- Standard FFB techniques were employed after patient stabilization on ECMO.
Main Results:
- No significant complications, including bleeding, were observed during or after FFB procedures.
- Three patients required temporary escalation of ECMO support post-procedure.
- Radiographic improvement was noted in 7/16 procedures for atelectasis; lung compliance improved or remained stable in 11/13 procedures.
- Bronchoalveolar lavage results guided therapeutic decisions in three patients with suspected pulmonary infections.
Conclusions:
- Flexible fiberoptic bronchoscopy with BW/BAL is a safe procedure for pediatric patients on VA-ECMO.
- FFB may offer diagnostic and therapeutic benefits for select pediatric patients requiring ECMO support.
Abstract:
Bleeding is one of the most feared complications of veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO), and is also a potential complication of flexible fiberoptic bronchoscopy (FFB). We retrospectively reviewed 14 patients who underwent FFB procedures with bronchial washings (BW) and bronchoalveolar lavage (BAL) to evaluate the safety of this procedure in children on ECMO. Standard FFB with BAL/BW technique was used after stabilization on ECMO. Three patients underwent two procedures each, and one patient underwent three, for a total of 19 procedures. No significant complications, such as bleeding have occurred. Three patients required additional ECMO support shortly after FFB. After the 16 procedures done for atelectasis, seven patients improved radiographically, three had increased opacifications, and six were unchanged. The remaining three patients had suspected pulmonary infections, and in each, therapeutic decisions were guided by the BAL results. Lung compliance was unchanged or improved after 11 of 13 procedures. We conclude that FFB with BAL/BW in children on ECMO is safe and may benefit certain patients.