Journal List > Allergy Asthma Respir Dis > v.4(3) > 1059176

Bae, Moon, Bang, Kim, Chun, Yoon, Kim, and Kim: Flexible bronchoscopy in 76 children: Indications, yield, and complications

Abstract

Purpose

This study was performed to investigate the indications, yield, and complications of flexible bronchoscopy for respiratory disease in children compared to earlier domestic studies and to examine if any differences existed in comparison to international studies.

Methods

The medical records of 100 cases of flexible bronchoscopy that were performed in 76 patients at the Department of Pediatrics of The Catholic University of Korea, Seoul St. Mary's Hospital from June 16, 2010 to August 6, 2013 were reviewed.

Results

A total of 76 patients (50 males and 26 females) were included in the study. The most common indication of flexible bronchoscopy was persistent pneumonia or pneumonia in immunocompromised patients (53 cases). The object of flexible bronchoscopy was accomplished in 65 of 100 cases, and, the treatment was changed in 24 of 65 cases. The most common abnormal finding was tracheomalacia that was found in 18 cases. In 67 cases where bronchoalveolar lavage was performed, bacteria were identified in 47 cases, fungi in 9 cases, and viruses in 22 cases. Complications occurred in 8 cases.

Conclusion

Compared to earlier domestic studies, there was no significant change in diagnostic approaches and therapeutic improvement. However, this study showed that flexible bronchoscopy appears to be safe in patients with hemato-oncologic disease. Compared to international studies, the occurrence of complications due to flexible bronchoscopy was relatively low.

Figures and Tables

Table 1

Characteristics of patients (n=76, case=100)

aard-4-181-i001
Characteristic No. of patients
Sex
 Male:female 50:26
Age
 <1 mo 9
 1 mo-1 yr 17
 1 yr-3 yr 16
 3 yr-10 yr 17
 10 yr-14 yr 15
 >14 yr 26
Underlying disease
 Hemato-oncologic disease 39
 Neurologic disease 15
 Pulmonary disease 10
 Cardiologic disease 5
 Prematurity 2
 Other anomaly 5
 No underlying disease 24
Table 2

Indication for pediatric flexible bronchoscopy (case=100)

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Variable No. of patients
Purpose
 Diagnostic 90
 Therapeutic 0
 Diagnostic and therapeutic 10
Indication
 Pneumonia (persistent or in immunocompromised patients) 53
 Stridor 11
 Persistent atelectasis 9
 Recurrent cyanosis (in airway anomaly patients) 8
 Suspicious foreign body aspiration 6
 Persistent wheezing 5
 Dyspnea 5
 Hemoptysis 3
Table 3

Yield of pediatric bronchoscopy (case=100)

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Variable No. of patients
Goal attainment 65
Changed treatment 24
Diagnosis change after procedure
 Microbiological identification 46
 Structural anomaly identification 36
 Foreign body 1
 Carcinoid tumor 1
Table 4

Bronchoscopic finding of patients (case=100)

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Finding No. of patients
Normal airway 40
Tracheomalacia 18
Secretion/mucus plugging 13
Laryngomalacia 12
Bronchomalacia 12
Airway collapse 6
Granulation tissue 6
Inflammation 4
Subglottic stenosis 3
Vocal cord/swelling 3
Focal narrowing of airway 2
Vocal cord immotility 1
Bleeding 1
Airway obstruction (endobronchial carcinoid) 1
Foreign body 1
Extrinsic compression 1

There were 23 cases with two or more flexible bronchoscopic findings.

Table 5

Cultured pathogens of bronchoalveolar lavage and bronchoscopic washing (case=68)

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Cultured finding No. of patients
Bacteria 47
Streptococcus viridans 7
Streptococcus pneumoniae 6
Staphylococcus aureus 5
Mycobacterium tuberculosis 5
Mycoplasma pneumoniae 3
Pseudomonas aeruginosa 3
Neisseria spp. 3
Acinetobacterbaumannii 2
Staphylococcus epidermidis 2
Acinetobacterhaemolyticus 1
Serratialiquefaciens 1
Moraxella catarrhalis 1
Stenotrophomonasmaltophilia 1
 Nontuberculosis Mycobacterium 1
Enterococcus faecium 1
Enterobacter cloacae 1
Haemophilus influenzae 1
Corynebacterium spp. 1
Eikenella corrodens 1
Staphylococcus hominis 1
Fungi 9
Aspergillus fumigatus 6
Pneumocystis jiroveci pneumoniae 2
Candida spp. 1
Virus 22
 Cytomegalovirus 5
 Rhinovirus 6
 Parainfluenza virus 4
 Bocavirus 4
 Respiratory syncytial virus 2
 Metapneumovirus 1

There were 22 cases that two or more pathogens were identified.

Table 6

Complications during the Procedure (case=100)

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Finding No. of patients
Bleeding 4
Convulsion 3
Apnea 1
Total 8
Table 7

Characteristics of main studies reporting pediatric bronchoscopy

aard-4-181-i007
Characteristic Current study Moon et al.7 Ahn et al.8 Peng et al.14 Manna and Durward11
Country South Korea South Korea South Korea Taiwan United Kingdom
Study period 3 yr (2010-2013) 3 yr (2007-2010) 7 yr (2001-2008) 4 yr (2005-2009) 2 yr (2002-2004)
Design Retrospective Retrospective Retrospective Retrospective Retrospective
Age 7 day-18 yr 5 day-18 yr 0-18 yr 1 day-17.5 yr 4 mo-6 yr
Single/multicenter Single center Single center Single center Single center single center
Bronchoscopic case 100 100 105 725 148
Indications Persistent pneumonia; stridor; persistent atelectasis; BAL; foreign body aspiration; Hemoptysis; wheezing Anatomic evaluation; respiratory distress; BAL; persistent atelectasis; extubation failure; foreign body aspiration; hemoptysis BAL; anatomic evaluation; respiratory distress; persistent atelectasis; foreign body aspiration; hemoptysis Anatomic evaluation; BAL; intubation; respiratory distress Anatomic evaluation; atelectasis; BAL; extubation failure; hemorrhage
Diagnostic yield Overall: 65.0% (65/100): change in medical management: 36.9% (24/65) Overall: 67.0% (67/100): change in management: 50.7% (34/67) Overall: 62.9% (66/105) Overall:87.2% (312/358): airway malacia: 47.8% (171/358): inflammatory changes: 39.4% (141/358) Overall:76.4% (113/148): upper airway: 84.4% (27/32); lower airway: 80.0% (56/70): CHD identified extraluminal compression: 18.6% (13/70): extubation failure: 90.5% (19/21): pulmonary disease: 44.0% (11/25)
Diagnostic BAL findings Identified organism: 67.6% (46/68) Identified organism: 63.3% (38/60) Identified organism: 44.7% (17/38) Identified organism: 35.3% (6/17)
Therapeutic outcomes Re-expanded collapsed lobe: 66.7% (6/9) Re-expanded collapsed lobe: 72.7% (8/11) Re-expanded collapsed lobe: 64.2% (9/14) 71.4% (518/725) of all FFB were interventional. Re-expanded collapsed lobe: 92.3% (24/26)
Complication Bleeding: 4.0% (4/100); convulsion: 3.0% (3/100); apnea: 1.0% (1/100) Fever: 4.0% (4/100); convulsion: 3.0% (3/100); dyspnea: 2.0% (2/100); bleeding: 1.0% (1/100); hypotension: 1.0% (1/100); vomiting: 1.0% (1/100) Bleeding: 3.8% (4/105); bronchospasm: 1.9% (2/105); fever: 1.0% (1/105); desaturation: 1.0% (1/105) Laryngospasm: 0.8% (6/725); pneumothorax: 0.3% (2/725); fever; 29.5% (214/725) Transient hypoxia: 10.8% (16/148); hypoxia of ARDS patients: 16.7% (3/18); hypotension: 17.6% (26/148); rigid chest after fentanyl: 0.6% (1/148)

BAL, bronchoalveolar lavage; ARDS, acute respiratory distress syndrome.

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