Development of an ultrathin fiberscope with a built-in channel for bronchoscopy in infants.

Flexible fiberoptic bronchoscopy (FFB) is of great importance for diagnostic and therapeutic purposes in pediatric respiratory management. However, lack of a built-in channel in commercially available ultrathin fiberscopes has limited its usefulness in neonates and infants. Bronchoscopic procedures, including suctioning, BAL, bronchography, and selective drug injection have instead been performed by temporary extubation followed by mask ventilation. However, such techniques are not suitable for repeated FFB and are open to considerable risks, especially in critically ill patients. In this context, we developed a directable ultrathin fiberscope with an external diameter of 2.7 mm and a 0.8-mm internal diameter built-in channel. This prototype fiberscope, the XPF27, is useful during spontaneous ventilation and can be inserted through a 3.5-mm or larger endotracheal tube. The XPF27 was utilized for 55 FFB procedures and allowed suctioning, BAL, bronchial toileting, and bronchography in 16 critically ill children without complications. We conclude that XPF27 is useful for pediatric FFB despite its limited flexibility, visual field, and resolution.