Retrospective evaluation of a paediatric intensivist-led flexible bronchoscopy service.
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.
Manna
Soumendu S
SS
Paediatric Intensive Care Unit, Evelina Children's Hospital, Guy's and Saint Thomas' NHS Trust, London, UK.
Durward
Andrew
A
Moganasundram
Shyamala
S
Tibby
Shane M
SM
Murdoch
Ian A
IA
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