Pediatric Bronchoscopy Praveen Khilnani, Mritunjay Pao
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Introduction: Flexible Fiberoptic BronchoscopyChapter 1

  • Praveen Khilnani
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Flexible fiberoptic bronchoscopy in children and infants is now recognized and accepted as a diagnostic and, to a certain degree, therapeutic modality.16
In the late 1970s, Robert E. Wood began promoting the direct examination of the tracheobronchial tree with specially constructed, flexible fiberoptic bronchoscopes (FFBs) suitable for use in infants and children.7,8
He is clearly responsible for laying foundation for pediatric flexible fiberoptic bronchoscopy (PFFB), and the training program. This greatly facilitated the use of technique and aided diagnosis and management of various disorders of respiratory tract including vocal cord palsy, laryngo-tracheomalacia,laryngeal web, subglottic stenosis, tracheal stenosis, tumors, inflammatory lesions, tuberculosis, foreign bodies and recurrent atelectasis.
In addition to diagnosis of various disorders PFFB has been instrumental in the following areas:
  1. Inspection of airways, primarily the trachea, before decannulation of tracheostomy tube or a change of tracheostomy tube to a smaller or larger size as clinically indicated.
  2. In cases of severe tracheomalacia, the FFB is used to measure the exact length from the tracheostomy skin stoma to carina. This enables ordering a custom-made tracheostomy tube with specified dimensions (Bivona or Shiley) that could serve as an effective stent.9
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  3. Measurements and photographic recording of tracheal and main-stem bronchi diameter is possible with the ultrathin FFB as levels of positive end expiratory pressure, bilevel positive airway pressure, or continuous positive airway pressure are adjusted.
  4. Guiding life-saving or difficult intubations in cervical traumatic injuries,10 or other conditions with difficult airway, as well as confirming patency or position of the endotracheal tube.
  5. Perform bronchoalveolar lavage as well as transbronchial biopsies.
  6. Perform the diagnosis and in some cases removal of foreign bodies.
  7. Placing tracheal or bronchial stents in patients with tracheobronchomalacia
In this part of the world PFFB is being used both as an outpatient and an inpatient procedure for diagnostic and therapeutic purposes, mostly by pediatric pulmonary specialists, pediatric intensivists and pediatric anesthesiologists (for difficult intubations). Rigid bronchoscopy is mainly performed by pediatric surgeons, thoracic surgeons and pediatric ENT specialists.
This text has been written with a purpose to familiarize reader with the indications and technique of FFB in neonates and pediatric age group. The equipment available for this purpose and its maintenance, sedation and anesthesia, post procedural 4care and complications are discussed. Techniques of use for airway inspection, bronchoalveolar lavage, transbronchial biopsy, foreign body removal and airway stent placement have also been described.
It is hoped that this text will be helpful to those already performing FFB or those wishing to learn this procedure.
REFERENCES
  1. Nussbaum E. Flexible fiberoptic bronchoscopy and laryngoscopy in infants and children. Laryngoscope 1983;93:1073–75.
  1. Nussbaum E: Flexible fiberoptic bronchoscopy and laryngoscopy in children under 2 years of age: Diagnostic and therapeutic applications of a new pediatric flexible fiberoptic bronchoscope. Crit Care Med 1982;10:770–72.
  1. Nussbaum E. Usefulness of miniature flexible fiberoptic bronchoscopy in children. Chest 1994;106:1438–42.
  1. Nussbaum E: Pediatric fiberoptic bronchoscopy. Clin Pediatr 1995;34:430–35.
  1. Fan LL, Sparks LM, Dulinski JP: Applications of an ultrathin flexible bronchoscope for neonatal and pediatric airway problems. Chest 1986;89:673–76.
  1. Wood RE: Pitfalls in the use of the flexible bronchoscope in pediatric patients. Chest 1990;97:199–203.
  1. Wood RE, Fink RJ: Applications of flexible fiberoptic bronchoscopes in infants and children. Chest 1978;73:737.
  1. Wood RE, Sherman JM: Pediatric flexible bronchoscopy. Ann Otol Rhinol Laryngol 1980;89:414–16.
  1. Miller RW, Pollack MM, Murphy TM, et al. Effectiveness of continuous positive airway pressure in the treatment of bronchomalacia in infants: A bronchoscopic documentation. Crit Care Med 1986;14:125–27.
  1. Rucker RW, Silva WJ, Worcester CC: Fiberoptic bronchoscopic nasotracheal intubation in children. Chest 1979;76:56–58.