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小儿重症监护医生的可弯曲支气管镜检查:手提包里的新工具?

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

作者信息

Chandnani Harsha K, Rodriguez Raul

机构信息

Department of Pediatrics, Division of Pediatric Critical Care, Loma Linda University Children's Hospital, Loma Linda, California, United States.

出版信息

J Pediatr Intensive Care. 2020 Jul 15;10(4):303-306. doi: 10.1055/s-0040-1713616. eCollection 2021 Nov.

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.

摘要

异物吸入(FBA)是意外受伤死亡的常见原因。现代支气管镜技术降低了FBA患儿的死亡率。在本文中,我们描述了一例16个月大患有难治性缺氧的患儿,由重症监护医生进行的柔性支气管镜检查迅速明确了病因并进行了恰当治疗。对于出现呼吸窘迫并伴有持续性缺氧的患者,应评估是否存在FBA,因为至少30%的病例初始胸部X线检查可能正常。接受过柔性支气管镜技术培训的重症监护医生拥有一项宝贵工具,可获取诊断信息,避免诊断延误以及启动不必要的治疗,如体外膜肺氧合。

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本文引用的文献

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A survey of training in pediatric flexible bronchoscopy.小儿可弯曲支气管镜检查培训调查
Pediatr Pulmonol. 2014 Jun;49(6):605-10. doi: 10.1002/ppul.22872. Epub 2013 Sep 5.
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Inhalation of foreign bodies in children: experience of 22 years.儿童异物吸入:22 年经验。
J Trauma Acute Care Surg. 2013 Feb;74(2):658-63. doi: 10.1097/TA.0b013e3182789520.
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Flexible bronchoscopy in pediatric intensive care.小儿重症监护中的柔性支气管镜检查
Pediatr Pulmonol. 2008 Dec;43(12):1188-92. doi: 10.1002/ppul.20910.
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Bronchoscopy in paediatric intensive care.
Paediatr Respir Rev. 2003 Mar;4(1):67-73. doi: 10.1016/s1526-0542(02)00313-5.

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