Tufts University School of Medicine, Boston, MA, USA.
Massachusetts Ear Nose and Throat Associates, Chelmsford, MA, USA.
Ann Otol Rhinol Laryngol. 2021 Feb;130(2):161-166. doi: 10.1177/0003489420942566. Epub 2020 Jul 16.
Prophylactic flexible bronchoscopy immediately following open airway reconstruction allows for directed clearance of the distal airways, potentially reducing the rate of certain postoperative respiratory complications. In this investigation, we sought to determine if prophylactic flexible bronchoscopy at the conclusion of pediatric open airway reconstruction has any benefit over blind flexible suctioning of the trachea.
A retrospective, single-center study at an urban tertiary care hospital was completed. From January 2010 to April 2013, patients underwent open airway reconstruction, immediately followed by blind flexible suctioning of the trachea for distal airway clearance. From May 2013 through December 2016, sequential patients underwent prophylactic flexible bronchoscopy immediately following airway reconstruction.
A total of 29 patients (age: 3.6 months-6.2 years) met inclusion criteria. Sixteen sequential patients underwent simple blind flexible suctioning and 13 sequential patients underwent directed, prophylactic flexible bronchoscopy. Demographics and comorbidities between the groups were equivalent other than slightly older age in the prophylactic bronchoscopy group. All clinical outcomes analyzed were equivalent other than faster time to room air ( < .002) and a decrease in the number of chest physical therapy sessions ( < .02) in a subset of patients who did not undergo prophylactic bronchoscopy.
This investigation suggests that the use of prophylactic flexible bronchoscopy immediately following open airway reconstruction may not be superior to blind flexible suctioning of the trachea in limiting postoperative pulmonary complications. Further studies of greater power are needed to better elucidate any small differences that may exist between these two interventions.
在开放气道重建后立即进行预防性软性支气管镜检查可直接清除远端气道，从而降低某些术后呼吸系统并发症的发生率。本研究旨在确定在儿科开放气道重建完成后，预防性软性支气管镜检查是否优于对气管进行盲目软性抽吸。
这是在一家城市三级护理医院进行的回顾性单中心研究。2010 年 1 月至 2013 年 4 月，患者接受开放气道重建，随后立即对气管进行盲目软性抽吸以清除远端气道。2013 年 5 月至 2016 年 12 月，连续的患者在气道重建后立即进行预防性软性支气管镜检查。
共有 29 名患者（年龄：3.6 个月至 6.2 岁）符合纳入标准。16 名连续患者接受了简单的盲目软性抽吸，13 名连续患者接受了定向、预防性软性支气管镜检查。两组患者的人口统计学和合并症除预防性支气管镜组年龄稍大外，其他均无差异。除未行预防性支气管镜检查的患者中更快达到空气室（ <.002）和减少胸部物理治疗次数（ <.02）外，分析的所有临床结果均无差异。
本研究表明，在开放气道重建后立即使用预防性软性支气管镜检查可能并不优于对气管进行盲目软性抽吸，以限制术后肺部并发症。需要进行更大规模的进一步研究，以更好地阐明这两种干预措施之间可能存在的任何微小差异。
