Flexible Bronchoscopy for the Pediatric Intensivist: A New Tool in the Handbag?

Abstract

Foreign body aspiration (FBA) is a common cause of unintentional-injury mortality. Modern bronchoscopy techniques have reduced mortality in children with FBA. In this article, we described a case of a 16-month-old child with refractory hypoxia where flexible bronchoscopy performed by the intensivist led to prompt etiology recognition and proper treatment. Patients presenting with respiratory distress with persistent hypoxia should be evaluated for FBA, considering initial chest X-ray can be normal in at least 30% of the cases. Intensivists trained in flexible bronchoscopy techniques possess a valuable tool to obtain diagnostic information avoiding delays in diagnosis and initiation of unnecessary therapies, such as extracorporeal membrane oxygenation.

Keywords

bronchoscopy - aspiration - foreign body

Publication History

Received: 30 March 2020

Accepted: 13 May 2020

Article published online:
15 July 2020

• References

• 1 Kramer TA, Riding KH, Salkeld LJ. Tracheobronchial and esophageal foreign bodies in the pediatric population. J Otolaryngol 1986; 15 (06) 355-358
• 2 Rovin JD, Rodgers BM. Pediatric foreign body aspiration. Pediatr Rev 2000; 21 (03) 86-90
• 3 Cramer N, Jabbour N, Tavarez MM, Taylor RS. Foreign body aspiration. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2019
• 4 Baram A, Sherzad H, Saeed S, Kakamad FH, Hamawandi AMH. Tracheobronchial foreign bodies in children: the role of emergency rigid bronchoscopy. Glob Pediatr Health 2017; 4: X17743663
• 5 Sahin A, Meteroglu F, Eren S, Celik Y. Inhalation of foreign bodies in children: experience of 22 years. J Trauma Acute Care Surg 2013; 74 (02) 658-663
• 6 Even L, Heno N, Talmon Y, Samet E, Zonis Z, Kugelman A. Diagnostic evaluation of foreign body aspiration in children: a prospective study. J Pediatr Surg 2005; 40 (07) 1122-1127
• 7 Oliveira CF, Almeida JF, Troster EJ, Vaz FAC. Complications of tracheobronchial foreign body aspiration in children: report of 5 cases and review of the literature. Rev Hosp Clin Fac Med Sao Paulo 2002; 57 (03) 108-111
• 8 Yuksel H, Yilmaz O, Acikel A, Basbay Y, Yasar A, Topcu I. First line treatment for foreign body aspiration in children: flexible bronchoscopy. Paediatr Bronchol 2018; 52 (62) PA624
• 9 Schramm D, Ling K, Schuster A, Nicolai T. Foreign body removal in children: recommendations versus real life—a survey of current clinical management in Germany. Pediatr Pulmonol 2017; 52 (05) 656-661
• 10 Bush A. Bronchoscopy in paediatric intensive care. Paediatr Respir Rev 2003; 4 (01) 67-73
• 11 Faro A, Wood RE, Schechter MS. et al; American Thoracic Society Ad Hoc Committee on Flexible Airway Endoscopy in Children. Official American Thoracic Society technical standards: flexible airway endoscopy in children. Am J Respir Crit Care Med 2015; 191 (09) 1066-1080
• 12 Davidson MG, Coutts J, Bell G. Flexible bronchoscopy in pediatric intensive care. Pediatr Pulmonol 2008; 43 (12) 1188-1192
• 13 Janahi IA, Khan S, Chandra P. et al. A new clinical algorithm scoring for management of suspected foreign body aspiration in children. BMC Pulm Med 2017; 17 (01) 61
• 14 Leong AB, Green CG, Kurland G, Wood RE. A survey of training in pediatric flexible bronchoscopy. Pediatr Pulmonol 2014; 49 (06) 605-610