Pediatric bronchoscopy
Flexible or rigid
Flexible bronchoscope
-Local anesethia
-mainly diagnostic purposes
-limited intervention (suctioning)
-can be used for intubation
- limited airway control
Indications:
=airway obstruction
-stridor
-noisy breathing
-snoring of uncertain anatomic origin
-persistent or recurenct wheeze.
=Evaluation of the artificial airway
=aid to the intubation of the difficult upper airway
=Vocal cord paralysis
=chronic cough
=hemoptysis
=suspected foreign body aspiration
=radiographic abnormalities :
-atelectasis
-recurent/persistent consolidation
-atypical and unknown infilteration
-localized hyperinflation
Special procedures:
_biopsy of endobronchial lesions
_brushing or biopsy of the brochial mucosa
_bronch0alveolar lavage
_transbroncial biopsy
_adminstration of drugs
C/I:
-dyspnea in non-intubated patients
-coagulopathy
Risks:
- patient discomfort and transient hypoxemia.
-With the addition of BAL, fever 4 to 12 h after the procedure is also common.
- More serious complications
-- pneumonia, respiratory failure, life-threatening hemoptysis, pneumothorax, and death -- are rare
Complication (6.9%)
. Minor complications (5.2%)
-moderate and transient episodes of desaturation
-excessive coughing isolated
-excessive nausea reflex with coughing
-transient laryngospasm
-epistaxis
. Major complications ( 1.7%)
-oxygen desaturation to <90%, either isolated or associated with: -laryngospasm
-coughing
- bronchospasm
- pneumothorax
. Transient fever after bronchoalveolar lavage
Rigid Bronchoscopy
General anesethia
-correct ventilatory support
-safe grasping with rigid forceps
-quick removal
-blood suctionning
Indications:
-bleeding or hemorrhage,
- foreign body extraction
-mucus pulgs or blood clots
-Defnition of anatomic details
-interventional bronchoscopy (laser,stents)
Contraindications:
-Relative contraindications include
- uncontrolled coagulopathy,
-Critically ill patients requiring mechanical ventilation
-Acute laryngitis
-Mandibular hypoplasia
Risks:
- injury to the teeth or gums,
- tracheal or bronchial tears,
- severe bleeding.
Complication rates should be < 0.1%.
Procedure-related mortality is rare.