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The Tools of the Trade — Uses of Flexible Bronchoscopy

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Abstract

Bronchoscopes have markedly improved the diagnosis as well as therapy in pediatric pulmonary disorders. Two types of bronchoscopes are available; flexible and rigid, with their own advantages and disadvantages. Depending on the clinical need and availability of skills, choice is made between the two. Typically, rigid scopes are largely used by the surgeons (pediatric or otolayngologists) while flexible bronchoscope stays in the domain of the pediatric pulmonologist and intensivists. Rigid scopes may be more versatile than flexible bronchoscopes in removing the foreign bodies from the airway. Flexible bronchoscopes on the other hand can even be introduced through an endotracheal tube. At times, use of both scopes may be required in a given patient for optimal results. Bronchoscopes give us a means to visualize the inside of the airway, which can be very informative for assessing various pathologies affecting the airways. Apart from the visualization of the parts of the airway tree and their structure as well as patency, it can also be used to take tissue biopsy specimens, collect secretions from the airways and bronchoalveolar lavage which can also get cellular elements from the distal alveoli. In the past few decades, more and more instruments are being used for expanding the utility of flexible bronchoscope for interventions ranging from bronchial toilet, foreign body removal, airway stenting and lasers or cryotherapy for airway lesions. The perinatologists have opened up more vistas and thrown newer challenges for using fiberoptic bronchoscopy (FB) for in utero tracheal occlusion in cases with diaphragmatic hernia. The vast applications of this tool makes it very relevant to pulmonary investigations and therapeutics.

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References

  1. Puhakka H, Kero P, Erkinjuntti M. Pediatric bronchoscopy during a 17-year period. Int J Pediatr Otorhinolaryngol. 1987;13:171–80.

    Article  CAS  PubMed  Google Scholar 

  2. Wood RE, Fink RJ. Applications of flexible fiberoptic bronchoscopes in infants and children. Chest. 1978;73:737–40.

    Article  CAS  PubMed  Google Scholar 

  3. Barbato A, Magarotto M, Crivellaro M, et al. Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres. Eur Respir J. 1997;10:1761–6.

    Article  CAS  PubMed  Google Scholar 

  4. Nicolai T. Pediatric bronchoscopy. Pediatr Pulmonol. 2001;31:150–64.

    Article  CAS  PubMed  Google Scholar 

  5. Konstan MW, Hilliard KA, Norvell TM, Berger M. Bronchoalveolar lavage findings in cystic fibrosis patients with stable, clinically mild lung disease suggest ongoing infection and inflammation. Am J Respir Crit Care Med. 1994;150:448–54.

    Article  CAS  PubMed  Google Scholar 

  6. Bush A, de Jongste JC, Carlsen K, Cokugras H. Ultrastructural examination of bronchial specimens from children with moderate asthma. Thorax. 2003;58:187–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Midulla F, de Blic J, Barbato A, et al. Flexible endoscopy of paediatric airways. Eur Respir J. 2003;22:698–708.

    Article  CAS  PubMed  Google Scholar 

  8. Gonzalez C, Eilly JS, Bluestone CD. Synchronous airway lesions in infancy. Ann Otol Rhinol Laryngol. 1987;96:77–80.

    Article  CAS  PubMed  Google Scholar 

  9. Mancuso RF. Stridor in neonates. Pediatr Clin North Am. 1996;43:1339–56.

    Article  CAS  PubMed  Google Scholar 

  10. Cerda J, Chacón J, Reichhard C, et al. Flexible fiberoptic bronchoscopy in children with heart diseases: a twelve years experience. Pediatr Pulmonol. 2007;42:319–24.

    Article  PubMed  Google Scholar 

  11. Knauer-Fischer S, Ratjen F. Lipid-laden macrophages in bronchoalveolar lavage fluid as a marker for pulmonary aspiration. Pediatr Pulmonol. 1999;27:419–22.

    Article  CAS  PubMed  Google Scholar 

  12. Bauer ML, Lyrene RK. Chronic aspiration in children: evaluation of the lipid-laden macrophage index. Pediatr Pulmonol. 1999;28:94–100.

  13. Ramírez-Figueroa JL, Gochicoa-Rangel LG, Ramírez-San Juan DH, Vargas MH. Foreign body removal by flexible fiberoptic bronchoscopy in infants and children. Pediatr Pulmonol. 2005;40:392–7.

    Article  PubMed  Google Scholar 

  14. Tang LF, Xu YC, Wang YS, et al. Airway foreign body removal by flexible bronchoscopy: experience with 1027 children during 2000–2008. World J Pediatr. 2009;5:191–5.

    Article  PubMed  Google Scholar 

  15. Dab I, Malfroot A, Goossens A. Therapeutic bronchoscopy in ventilated neonates. Arch Dis Child. 1993;69:533–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Schellhase DE. Routine fiberoptic bronchoscopy in intubated neonates? Am J Dis Child. 1990;144:746–7.

    CAS  PubMed  Google Scholar 

  17. Bar-Zohar D, Sivan Y. The yield of flexible fiberoptic bronchoscopy in pediatric intensive care patients. Chest. 2004;126:1353–9.

    Article  PubMed  Google Scholar 

  18. Languepin J, Scheinmann P, Mahut B, et al. Bronchial casts in children with cardiopathies. Pediatr Pulmonol. 1999;28:329–36.

    Article  CAS  PubMed  Google Scholar 

  19. Chapotte C, Monrigal JP, Pezard P, et al. Airway compression in children due to congenital heart disease: value of flexible fiberoptic bronchoscopic assessment. J Cardiothorac Vasc Anesth. 1998;12:145–52.

  20. Godfrey S, Avital A, Maayan C, Rotschild M, Springer C. Yield from flexible bronchoscopy in children. Pediatr Pulmonol. 1997;23:261–9.

    Article  CAS  PubMed  Google Scholar 

  21. Kaparianos A, Argyropoulou E, Sampsonas F, et al. Indications, results and complications of flexible fiberoptic bronchoscopy: a 5-year experience in a referral population in Greece. Eur Rev Med Pharmacol Sci. 2008;12:355–63.

    CAS  PubMed  Google Scholar 

  22. Maffey AF, Berlinski A, Schkair JC, Teper AM. Flexible bronchoscopy in a pediatric pulmonology service. Arch Argent Pediatr. 2008;106:19–25.

    PubMed  Google Scholar 

  23. Kabra SK, Lodha R, Ramesh P, Sarthi M. Fiberoptic bronchoscopy in children: an audit from a tertiary care center. Indian Pediatr. 2008;45:917–9.

    CAS  PubMed  Google Scholar 

  24. Woodhull S, Goh Eng Neo A, Tang Poh Lin J, Chay OM. Pediatric flexible bronchoscopy in Singapore: a 10-year experience. J Bronchology Interv Pulmonol. 2010;17:136–41.

  25. Vijayasekaran D, Kalpana S, Ramachandran P, Nedunchelian K. Indications and outcome of flexible bronchoscopy in neonates. Indian J Pediatr. 2012;79:1181–4.

    Article  CAS  PubMed  Google Scholar 

  26. Kirvassilis F, Gidaris D, Ventouri M, et al. Flexible fiberoptic bronchoscopy in Greek children. Hippokratia. 2011;15:312–5.

    PubMed Central  CAS  PubMed  Google Scholar 

  27. Nussbaum E. Pediatric fiberoptic bronchoscopy: clinical experience with 2,836 bronchoscopies. Pediatr Crit Care Med. 2002;3:171–6.

    Article  PubMed  Google Scholar 

  28. Field-Ridley A, Sethi V, Murthi S, Nandalike K, Li ST. Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: a systematic review. World J Crit Care Med. 2015;4:77–88.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Cote CJ, Wilson S; for the Work Group on Sedation American Academy of Pediatrics. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118:2587–602.

  30. Smyth AR, Bowhay AR, Heaf LJ, Smyth RL. The laryngeal mask airway in fibreoptic bronchoscopy. Arch Dis Child. 1996;75:344–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. deBlic J, Marchac V, Scheinmann P. Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures. Eur Respir J. 2002;20:1271–6.

    Article  CAS  Google Scholar 

  32. Masters IB, Cooper P. Paediatric flexible bronchoscopy- position paper. J Paediatr Child Health. 2002;38:555–9.

    Article  CAS  PubMed  Google Scholar 

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VS and KKS both reviewed the literature and prepared the manuscript. VS will act as guarantor for this paper.

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Correspondence to Varinder Singh.

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Singh, V., Singhal, K.K. The Tools of the Trade — Uses of Flexible Bronchoscopy. Indian J Pediatr 82, 932–937 (2015). https://doi.org/10.1007/s12098-015-1869-1

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