title: Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: A systematic review.
abstract: OBJECTIVE
  To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to flexible fiberoptic bronchoscopy (FFB) in critically ill children.
  
  
  METHODS
  We searched PubMed, SCOPUS, OVID, and EMBASE databases through July 2014 for English language publications studying FFB performed in the intensive care unit in children < 18 years old. We identified 666 studies, of which 89 full-text studies were screened for further review. Two reviewers independently determined that 27 of these studies met inclusion criteria and extracted data. We examined the diagnostic yield of FFB among upper and lower airway evaluations, as well as the utility of bronchoalveolar lavage (BAL).
  
  
  RESULTS
  We found that FFB led to a change in medical management in 28.9% (range 21.9%-69.2%) of critically ill children. The diagnostic yield of FFB was 82% (range 45.2%-100%). Infectious organisms were identified in 25.7% (17.6%-75%) of BALs performed, resulting in a change of antimicrobial management in 19.1% (range: 12.2%-75%). FFB successfully re-expanded atelectasis or removed mucus plugs in 60.3% (range: 23.8%-100%) of patients with atelectasis. Adverse events were reported in 12.9% (range: 0.5%-71.4%) of patients. The most common adverse effects of FFB were transient hypotension, hypoxia and/or bradycardia that resolved with minimal intervention, such as oxygen supplementation or removal of the bronchoscope. Serious adverse events were uncommon; 2.1% of adverse events required intervention such as bag-mask ventilation or intubation and atropine for hypoxia and bradycardia, normal saline boluses for hypotension, or lavage and suctioning for hemorrhage.
  
  
  CONCLUSIONS
  FFB is safe and effective for diagnostic and therapeutic use in critically ill pediatric patients.
authors: Aida Field-Ridley, Viyeka Sethi, Shweta Murthi, Kiran Nandalike, Su-Ting T Li, Department of Pediatrics, University of California Davis, Sacramento, CA 95618, United States.
authors: Aida
authors: A
authors: Field-Ridley
authors: Aida Field-Ridley, Viyeka Sethi, Shweta Murthi, Kiran Nandalike, Su-Ting T Li, Department of Pediatrics, University of California Davis, Sacramento, CA 95618, United States.
authors: Viyeka
authors: V
authors: Sethi
authors: Aida Field-Ridley, Viyeka Sethi, Shweta Murthi, Kiran Nandalike, Su-Ting T Li, Department of Pediatrics, University of California Davis, Sacramento, CA 95618, United States.
authors: Shweta
authors: S
authors: Murthi
authors: Aida Field-Ridley, Viyeka Sethi, Shweta Murthi, Kiran Nandalike, Su-Ting T Li, Department of Pediatrics, University of California Davis, Sacramento, CA 95618, United States.
authors: Kiran
authors: K
authors: Nandalike
authors: Aida Field-Ridley, Viyeka Sethi, Shweta Murthi, Kiran Nandalike, Su-Ting T Li, Department of Pediatrics, University of California Davis, Sacramento, CA 95618, United States.
authors: Su-Ting T
authors: ST
authors: Li
keywords: Bronchoalveolar lavage; Bronchoscopy; Critical illness; Pediatrics; Pulmonary disease