Published online Feb 4, 2015. doi: 10.5492/wjccm.v4.i1.77
Peer-review started: October 21, 2014
First decision: November 27, 2014
Revised: December 16, 2014
Accepted: January 9, 2015
Article in press: January 12, 2015
Published online: February 4, 2015
AIM: 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.
CONCLUSION: FFB is safe and effective for diagnostic and therapeutic use in critically ill pediatric patients.
Core tip: Flexible fiberoptic bronchoscopy (FFB) is effective and safe for diagnostic and therapeutic use among critically ill pediatric patients. FFB led to change in management in 28.9% of patients, with a diagnostic yield of 82%. Bronchoalveolar lavage obtained during FFB may assist with identifying infectious organisms (25.7%) and optimizing antimicrobial therapy (19.1%). FFB had therapeutic benefit with removal of mucus plugs or resolution of atelectasis in 60.3%. The majority of reported adverse events were transient and included hypotension, hypoxia and/or bradycardia requiring minimal intervention.