Flexible bronchoscopy and bronchoalveolar lavage in pediatric patients with lung disease.
OBJECTIVE
The use of flexible bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in investigating pediatric patient with airway abnormalities and pulmonary infiltrates are indispensable and are now a routine procedure in many centers. Immunocompromised and cancer patients, especially after bone marrow transplantation, and children who have undergone surgery for congenital heart disease (CHD) are at high risk for pulmonary disease. Our aim was to study the diagnostic rate, safety, and clinical yield of FOB in critically ill pediatric patients.


METHODS
: Retrospective chart review.


METHODS
Pediatric intensive care unit in a tertiary university hospital.


METHODS
Three hundred nineteen children who underwent 335 FOB procedures. The indications for bronchoscopy included infectious agent identification in immune-competent patients with new pulmonary infiltrates seen on chest radiograph (46%) and in patients with fever and neutropenia with respiratory symptoms (18%), airway anatomy evaluation in patients with upper airway obstruction (16%), CHD (15%), and airway trauma (5%). Data were obtained by reviewing the patients' charts, bronchoscopy reports, and laboratory results.


RESULTS
The diagnostic rate of FOB procedures was 79%. FOB and BAL resulted in alteration of management (positive clinical yield) in 70 patients (23.9%). A definite infectious organism was identified in 56 patients (17.6%). The clinical yield in patients with cancer or primary immune deficiency (38.7%) was significantly higher compared with patients with CHD (20.4%, p < 0.01) and pneumonia (17%, p < 0.01). Major complications were observed in two procedures (prolonged apnea), and minor complications (transient desaturation, stridor, and minor bleeding) were observed in 45 patients (14%).


CONCLUSIONS
FOB and BAL have an important role in the evaluation of airway abnormality and pulmonary infiltrate in pediatric patients, in whom rapid and accurate diagnosis is crucial for survival. We suggest that FOB should be considered as an initial diagnostic tool in those critically ill patients.
Efrati
Ori
O
Pediatric Pulmonology Unit, Safra Children's Hospital, The Sheba Medical Center, Tel-Hashomer, Israel. ori.efrati@sheba.health.gov.il
Sadeh-Gornik
Udi
U
Modan-Moses
Dalit
D
Barak
Asher
A
Szeinberg
Amir
A
Vardi
Amir
A
Paret
Gidon
G
Toren
Amos
A
Vilozni
Daphna
D
Yahav
Yaacov
Y
D018893:Bronchoalveolar Lavage / Q000379:methods*; D020680:Bronchoscopes; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D015278:Intensive Care Units, Pediatric; D008171:Lung Diseases / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D008175:Lung Neoplasms / Q000175:diagnosis / Q000628:therapy; D008297:Male; D018583:Pliability; D011336:Probability; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000175:diagnosis / Q000628:therapy