Related Experiment Videos
Yield from flexible bronchoscopy in children
S Godfrey1, A Avital, C Maayan
1Institute of Pulmonology, Hadassah University Hospital, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Insights
Flexible fiberoptic bronchoscopy in children provides valuable diagnostic information, significantly aiding clinical management. Combining airway inspection with bronchoalveolar lavage and microbiology offers a high yield of useful data.
Area of Science:
- Pediatric Pulmonology
- Diagnostic Procedures
- Respiratory Medicine
Background:
- Flexible fiberoptic (FO) bronchoscopy is now a standard diagnostic tool in pediatric care.
- It has largely replaced rigid open tube (OT) bronchoscopy for evaluating pediatric airway conditions.
Purpose of the Study:
- To assess the clinical management contribution of FO bronchoscopy in children with specific respiratory issues.
- To evaluate the combined utility of airway inspection, bronchoalveolar lavage (BAL), and microbiology.
Main Methods:
- Retrospective analysis of the first 200 flexible bronchoscopies in children under 18.
- Indications included noisy breathing, recurrent pneumonia, suspected pneumonia, atelectasis, foreign body aspiration, and others.
- Data collected on airway inspection findings, BAL cytology, bacterial, and fungal cultures.
Main Results:
- Airway abnormalities were found in 67.0% of cases, impacting management in 67.5%.
- BAL cytology was abnormal in 80.4%, aiding management primarily in recurrent pneumonia cases.
- Combined diagnostic methods (inspection, BAL, microbiology) contributed to management in 90.5% of patients.
Conclusions:
- Flexible fiberoptic bronchoscopy is highly effective for pediatric airway diagnosis.
- Integrating BAL and microbiological analysis significantly enhances its clinical utility.
- This comprehensive approach yields substantial, actionable information for managing pediatric respiratory conditions.
Abstract:
Flexible fiberoptic (FO) bronchoscopy can now be undertaken readily in children using topical anesthesia and light sedation and has largely supplanted rigid open tube (OT) bronchoscopy for diagnostic purposes. The present study examined the contribution of the FO bronchoscope to clinical management in children presenting with specific types of problems. We examined the first 200 consecutive flexible bronchoscopies performed in 1995 in children under 18 years of age (median age, 2.27 years). Indications for bronchoscopy were noisy breathing (26.5%), recurrent pneumonia (21.0%), suspected pneumonia in an immunocompromised patient (10.5%), atelectasis or bronchial toilet (12.5%), possible foreign body aspiration (13.0%), and miscellaneous other reasons (16.5%). Inspection of the airway was abnormal in 67.0% of all investigations and made a clinically meaningful contribution to management in 67.5%, especially in those with noisy breathing (98.1%), possible foreign body aspiration (100%), and atelectasis (76.0%). Bronchoalveolar lavage (BAL) cytology was abnormal in 80.4% of the 107 lavages, but contributed little to management except in those with recurrent pneumonia (73.8%). Bacteria were isolated in 26.6% of the 109 specimens cultured, but this finding rarely affected management. Fungi were isolated in 47.4% of the 19 lavages in the immunocomprised group. Together, inspection, BAL and microbiology contributed to management in a mean of 90.5% (range, 76.2-100%) of patients in the various groups. We concluded that a high yield of clinically meaningful information can be expected from FO bronchoscopy in children when coupled with BAL and microbiological studies of lavage fluid.