title: Use of flexible bronchoscopy in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support.
abstract: BACKGROUND
  Critically ill children treated with extracorporeal membrane oxygenation (ECMO) support frequently have respiratory complications amenable to evaluation by flexible bronchoscopy (FB). The safety and efficacy of FB in this setting has not been well described in children.
  
  
  METHODS
  Retrospective analysis of 153 FBs in 79 children treated with ECMO at a single institution from 2000 to 2008. Demographic data, clinical findings, and complications were obtained. Chest radiographs reports were evaluated prior to and following FB. Physiologic variables were compared prior to and following FB.
  
  
  RESULTS
  Seventy-nine patients underwent FB on ECMO [58 veno-venous (VV) and 21 veno-arterial (VA) ECMO], with 153 total FBs performed. Indications for FB included clearance of tenacious airway secretions (n = 118, 77%), or evaluation of suspected secondary infections with bronchoalveolar lavage (n = 26, 17%). Two patients also had surfactant instillation following secretion removal. FB was performed a median 5 days following cannulation for ECMO (range 2-14 days). Most common findings included thick secretions (n = 77, 50.3%), mucoid secretions (n = 15, 9.8%), and mucopurulent secretions (n = 28, 18.3%). No deterioration in radiographic lung findings was described post-FB. FB was not associated with any significant change in heart rate, systemic blood pressure, or temperature. No significant changes in ECMO pump flow rate or sweep gas flow was seen during or after FB. Cannula dislodgement, inadvertent extubation, fever, pneumothorax, or intraprocedural hypoxemia was not reported. Fifty-three FBs (35%) resulted in blood-tinged secretions from the endotracheal tube post-FB, which resolved spontaneously. Three patients received high frequency oscillatory ventilation (HFOV) following FB in association with mild hemorrhage.
  
  
  CONCLUSIONS
  FB is a well-tolerated and safe procedure in critically ill pediatric patients on ECMO. FB may have a diagnostic as well as therapeutic benefit in such patients.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA. pkee72@hotmail.com
authors.forename: Pradip P
authors.initials: PP
authors.lastname: Kamat
authors.forename: Jonathan
authors.initials: J
authors.lastname: Popler
authors.forename: Joel
authors.initials: J
authors.lastname: Davis
authors.forename: Traci
authors.initials: T
authors.lastname: Leong
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Piland
authors.forename: Dawn
authors.initials: D
authors.lastname: Simon
authors.forename: Alan
authors.initials: A
authors.lastname: Harsch
authors.forename: William G
authors.initials: WG
authors.lastname: Teague
authors.forename: James D
authors.initials: JD
authors.lastname: Fortenberry
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism; D008297:Male; D009093:Mucus / Q000378:metabolism; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013501:Surface-Active Agents / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013501:Surface-Active Agents