title: Retrospective evaluation of a paediatric intensivist-led flexible bronchoscopy service.
abstract: OBJECTIVE
  To demonstrate the diagnostic yield, therapeutic role and safety of flexible bronchoscopy via an intensivist-led service in critically ill children.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Regional paediatric intensive care unit.
  
  
  RESULTS
  One hundred forty-eight flexible bronchoscopies were performed by two intensivists on 134 patients (median age 16.5 months) over a 2.5-year period. Eighty-eight percent of patients required mechanical ventilation, and 22% were receiving inotropes. Case mix included general (n = 77), cardiac surgery (n = 18), cardiology (n = 13), ear-nose-and-throat surgery (n = 17), oncology (n = 8) and renal (n = 1). The indication for bronchoscopy was defined a priori according to one of four categories: suspected upper airway disease (n = 32); lower airway disease (n = 70); investigation of pulmonary disease (n = 25); and extubation failure (n = 21). Bronchoscopy was generally performed soon after PICU admission, at a median time of 1.5 days for the former three categories, and 4 days for extubation failure group. A positive yield from bronchoscopy (diagnosis that explained the clinical condition or influenced patient management) was present in 113 of 148 (76%) procedures, varying within groups from 44% (pulmonary disease) to 90% (extubation failure). Ten percent of patients developed a fall in oxygen saturations > 20% during the procedure and 17% required a bolus of at least 10 ml/kg of 0.9% saline for hypotension.
  
  
  CONCLUSIONS
  Critically ill patients with respiratory problems may benefit from a PICU-led bronchoscopy service as the yield for positive bronchoscopic finding is high, particularly for upper airway problems or extubation failure.
authors.affiliation: Paediatric Intensive Care Unit, Evelina Children's Hospital, Guy's and Saint Thomas' NHS Trust, London, UK.
authors.forename: Soumendu S
authors.initials: SS
authors.lastname: Manna
authors.forename: Andrew
authors.initials: A
authors.lastname: Durward
authors.forename: Shyamala
authors.initials: S
authors.lastname: Moganasundram
authors.forename: Shane M
authors.initials: SM
authors.lastname: Tibby
authors.forename: Ian A
authors.initials: IA
authors.lastname: Murdoch
mesh_terms: D001999:Bronchoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay; D008171:Lung Diseases / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies