Journal List > Allergy Asthma Respir Dis > v.1(3) > 1058969

Chun, Kang, Bang, Kim, Lee, Yoon, Kim, Kim, and Lee: Usefulness of flexible bronchoscopy in treatment of atelectasis in children

Abstract

Purpose

This study was to evaluate the effect of flexible bronchoscopy for the treatment of secondary atelectasis of children following respiratory infection.

Methods

The medical records for a total of 19 cases of flexible bronchoscopy were reviewed retrospectively, which were performed for the treatment of secondary atelectasis at the Department of Pediatrics of the Catholic University of Korea Seoul St. Mary's Hospital from April 2007 to January 2013.

Results

A total of 18 patients (11 males and 7 females) were involved in the study. The range of age was 4 months to 15 years old. The causative underlying diseases were 17 cases of pneumonia, 1 case of bronchiolitis and 1 case of bronchial asthma. The most common location of atelectasis was right middle lobe and right middle lobe with left lower lobe was next. Bronchoscopy revealed inflammatory changes in 12 cases (63.2%) such as mucus plug (n=4), profuse secretion (n=4), mucosal edema (n=3), and bronchial narrowing (n=1), although 7 cases (36.8%) showed normal airway. Other additional findings were bronchomalacia, tracheomalacia, and bronchial tree abnormality. Seven out of 19 cases who received therapeutic intervention had complete or partial reexpansion of their atelectasis. Cases who occurred atelectasis within 6 weeks showed significantly higher improvement than cases occurred after 6 weeks (70% vs. 11.1%, P=0.019). Complications including seizure, fever, hypoxia, mucous bleeding, and hypotension were observed in 6 cases.

Conclusion

Flexible bronchoscopy revealed to be effective and safe treatment modality in treatment of secondary atelectasis of children. Timely therapeutic intervention in pediatric patients should be considered.

Figures and Tables

Table 1
Characteristics of patients
aard-1-274-i001
Table 2
Location of atelectasis in 19 cases
aard-1-274-i002
Table 3
Bronchoscopic findings of 19 cases
aard-1-274-i003
Table 4
Comparison of clinical outcome according to the duration of atelectasis
aard-1-274-i004

SD, standard deviation.

References

1. Carlsen KH, Smevik B. Atelectasis. In : Taussig LM, Landau LI, editors. Pediatric respiratory medicine. 2nd ed. St. Louis: Mosby;2008. p. 1005–1013.
2. Peroni DG, Boner AL. Atelectasis: mechanisms, diagnosis and management. Paediatr Respir Rev. 2000; 1:274–278.
crossref
3. Livingston GL, Holinger LD, Luck SR. Right middle lobe syndrome in children. Int J Pediatr Otorhinolaryngol. 1987; 13:11–23.
crossref
4. Wood RE. Clinical applications of ultrathin flexible bronchoscopes. Pediatr Pulmonol. 1985; 1:244–248.
crossref
5. Priftis KN, Mermiri D, Papadopoulou A, Anthracopoulos MB, Vaos G, Nicolaidou P. The role of timely intervention in middle lobe syndrome in children. Chest. 2005; 128:2504–2510.
crossref
6. Shin MY, Hwang JH, Chung EH, Moon JH, Lee JS, Park YM, et al. Flexible Bronchoscopic Findings and Therapeutic Effects in Atelectasis of Children. J Korean Pediatr Soc. 2002; 45:1090–1096.
7. Ahn HS, Choi EJ, Yun HJ, Wang SW, Kwon EY, Hwang KG, et al. The Clinical Experience of Pediatric Flexible Bronchoscopy at a Single Institution. Pediatr Allergy Respir Dis. 2011; 21:226–233.
crossref
8. Tang LF, Chen ZM. Fiberoptic bronchoscopy in neonatal and pediatric intensive care units: a 5-year experience. Med Princ Pract. 2009; 18:305–309.
crossref
9. Raman TS, Mathew S, Ravikumar , Garcha PS. Atelectasis in children. Indian Pediatr. 1998; 35:429–435.
10. Woodring JH, Reed JC. Types and mechanisms of pulmonary atelectasis. J Thorac Imaging. 1996; 11:92–108.
crossref
11. Millman M, Goodman AH, Goldstein IM, Millman FM, Van Campen SS. Treatment of a patient with chronic bronchial asthma with many bronchoscopies and lavages using acetylcysteine: a case report. J Asthma. 1985; 22:13–35.
crossref
12. Stiksa G, Nemcek K, Melin S. Effects of inhaled N-acetylcysteine in combination with terbutaline. Eur J Respir Dis. 1984; 65:278–282.
13. Millman M, Millman FM, Goldstein IM, Mercandetti AJ. Use of acetylcysteine in bronchial asthma--another look. Ann Allergy. 1985; 54:294–296.
14. Solé-Violán J, Rodriguez de, Rey A, Martin-Gonzalez JC, Cabrera-Navarro P. Usefulness of microscopic examination of intracellular organisms in lavage fluid in ventilator-associated pneumonia. Chest. 1994; 106:889–894.
crossref
15. Coppolo DP, Brienza LT, Pratt DS, May JJ. A role for the respiratory therapist in flexible fiberoptic bronchoscopy. Respir Care. 1985; 30:323–327.
TOOLS
Similar articles