Department of Pediatrics, Division of Pediatric Emergency, Critical Care and Pulmonology, Sir Ganga Ram Hospital, New Delhi, India.
Department of Pediatrics, Division of Pediatric Emergency and Critical Care, Sir Ganga Ram Hospital, New Delhi, India.
Pediatr Pulmonol. 2022 May;57(5):1310-1317. doi: 10.1002/ppul.25863. Epub 2022 Mar 2.
To study the utility, safety, and effects of flexible fiberoptic bronchoscopy (FFB) on oxygenation status, ventilation parameters, and hemodynamics in mechanically ventilated children.
Retrospective study.
Children aged >1 month to 18 years suffering from critical medical and surgical diseases.
First bronchoscopy data of 131 patients were analyzed. Indication, FFB findings, the microbiological yield from bronchoalveolar lavage, and medical and surgical interventions based on FFB results were recorded. Hemodynamic and ventilation parameters before, during, and 3 h after FFB were also captured. The majority of bronchoscopies were done for diagnostic purposes with a positivity rate of 90.8%. Retained mucopurulent secretion in the airways was the commonest finding in 60 patients. A cause for weaning or extubation failure could be identified in 83.3%. Post-FFB radiological resolution of atelectasis was seen in 34/59 (57.6%; p-value: 0.001) chest radiographs. Forty-seven medical and 25 surgical interventions were done depending on FFB and BAL findings. There was a significant drop in oxygenation parameters and a rise in heart rate during FFB (p-value: <0.0001). The peak inspiratory pressure, positive end-expiratory pressure, and mean airway pressure increased significantly during bronchoscopy (p value: <.0001) while patients were on pressure-regulated volume-controlled ventilation. All these changes reversed to pre-FFB levels. There were minor procedure-related complications.
FFB was an important diagnostic and therapeutic tool for mechanically ventilated children and the results helped plan interventions. It was a safe procedure with transient reversible cardiopulmonary alterations.
研究软性纤维支气管镜（FFB）对机械通气儿童氧合状态、通气参数和血流动力学的作用、安全性。
回顾性研究。
患有严重内科和外科疾病的 >1 个月至 18 岁儿童。
分析了 131 例患者的首次支气管镜检查数据。记录了检查适应证、FFB 结果、支气管肺泡灌洗的微生物产量以及根据 FFB 结果进行的内科和外科干预。还记录了 FFB 前、中、后 3 小时的血流动力学和通气参数。大多数支气管镜检查是为了诊断目的，阳性率为 90.8%。在 60 例患者中最常见的发现是气道中残留的黏液脓性分泌物。83.3%的患者可以确定导致撤机或拔管失败的原因。在 59 例胸部 X 线片中（57.6%；p 值：0.001），FFB 后影像学上的肺不张得到了改善。根据 FFB 和 BAL 结果进行了 47 次内科和 25 次外科干预。在 FFB 期间，氧合参数显著下降，心率升高（p 值：<0.0001）。在压力调节容量控制通气期间，吸气峰压、呼气末正压和平均气道压显著增加（p 值：<.0001）。所有这些变化都恢复到 FFB 前的水平。有轻微的与程序相关的并发症。
FFB 是机械通气儿童的重要诊断和治疗工具，其结果有助于计划干预措施。它是一种安全的程序，有短暂的可逆转心肺改变。
