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Verma R, Mocanu C, Shi J, Miller MR, Chiang J, Wolter NE, Propst EJ, St-Laurent A, Amin R. Decannulation following tracheostomy in children: A systematic review of decannulation protocols. Pediatr Pulmonol 2021; 56:2426-2443. [PMID: 34231976 DOI: 10.1002/ppul.25503] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To provide a systematic review of the existing pediatric decannulation protocols, including the role of polysomnography, and their clinical outcomes. METHODS Five online databases were searched from database inception to May 29, 2020. Study inclusion was limited to publications that evaluated tracheostomy decannulation in children 18 years of age and younger. Data extracted included patient demographics and primary indication for tracheostomy. Methods used to assess readiness for decannulation were noted including the use of bronchoscopy, tracheostomy tube modifications, and gas exchange measurements. After decannulation, details regarding mode of ventilation, location, and length of observation period, and clinical outcomes were also collected. Descriptive statistical analyses were performed. RESULTS A total of 24 studies including 1395 children were reviewed. Tracheostomy indications included upper airway obstruction at a well-defined anatomic site (35%), upper airway obstruction not at a well-defined site (12%) and need for long-term ventilation and pulmonary care (53%). Bronchoscopy was routinely used in 23 of 24 (96%) protocols. Tracheostomy tube modifications in the protocols included capping (n = 20, 83%), downsizing (n = 14, 58%), and fenestrations (n = 2, 8%). Measurements of gas exchange included polysomnography (n = 13/18, 72%), oximetry (n = 10/18, 56%), blood gases (n = 3,17%), and capnography (n = 3, 17%). After decannulation, children in 92% of protocols were transitioned to room air. Observation period of 48 h or less was used in 76% of children. CONCLUSIONS There exists large variability in pediatric decannulation protocols. Polysomnography plays an integral role in assessing most children for tracheostomy removal. Evidence-based guidelines to standardize pediatric tracheostomy care remain an urgent priority.
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Affiliation(s)
- Rahul Verma
- Department of Pediatrics, Children's Hospital, Western University, London, Ontario, Canada
| | - Cora Mocanu
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Jenny Shi
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael R Miller
- Department of Pediatrics, Children's Hospital, Western University, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Jackie Chiang
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Aaron St-Laurent
- Division of Respiratory Medicine, Children's Hospital, Western University, London, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences (CHES) SickKids Research Institute, Toronto, Ontario, Canada
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Schramm D, Freitag N, Nicolai T, Wiemers A, Hinrichs B, Amrhein P, DiDio D, Eich C, Landsleitner B, Eber E, Hammer J. Pediatric Airway Endoscopy: Recommendations of the Society for Pediatric Pneumology. Respiration 2021; 100:1128-1145. [PMID: 34098560 DOI: 10.1159/000517125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
For many decades, pediatric bronchoscopy has been an integral part of the diagnosis and treatment of acute and chronic pulmonary diseases in children. Rapid technical advances have continuously influenced the performance of the procedure. Over the years, the application of pediatric bronchoscopy has considerably expanded to a broad range of indications. In this comprehensive and up-to-date guideline, the Special Interest Group of the Society for Pediatric Pneumology reviewed the most recent literature on pediatric bronchoscopy and reached a consensus on a safe technical performance of the procedure.
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Affiliation(s)
- Dirk Schramm
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Nicolai
- University Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Anna Wiemers
- Ruhr University Bochum, St. Josef-Hospital, University Hospital of Pediatrics and Adolescent Medicine, Department of Pediatric Pulmonology, Bochum, Germany
| | - Bernd Hinrichs
- Pediatric Practice Buchholz and Asklepios Medical School Hamburg, Hamburg, Germany
| | - Peter Amrhein
- Department of Pediatric Otorhinolaryngology, Klinikum Stuttgart Katharinenhospital, Olgahospital, Stuttgart, Germany
| | - Diana DiDio
- Department of Pediatric Otorhinolaryngology, Klinikum Stuttgart Katharinenhospital, Olgahospital, Stuttgart, Germany
| | - Christoph Eich
- Department of Anesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Bernd Landsleitner
- Department of Anaesthesia and Intensive Care Medicine, Hallerwiese Clinic-Cnopf Children's Hospital, Nuremberg, Germany
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Jürg Hammer
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
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Goussard P, Pohunek P, Eber E, Midulla F, Di Mattia G, Merven M, Janson JT. Pediatric bronchoscopy: recent advances and clinical challenges. Expert Rev Respir Med 2021; 15:453-475. [PMID: 33512252 DOI: 10.1080/17476348.2021.1882854] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: During the last 40 years equipment has been improved with smaller instruments and sufficient size working channels. This has ensured that bronchoscopy offers therapeutic and interventional options.Areas covered: We provide a review of recent advances and clinical challenges in pediatric bronchoscopy. This includes single-use bronchoscopes, endobronchial ultrasound, and cryoprobe. Bronchoscopy in persistent preschool wheezing and asthma is included. The indications for interventional bronchoscopy have amplified and included balloon dilatation, endoscopic intubation, the use of airway stents, whole lung lavage, closing of fistulas and air leak, as well as an update on removal of foreign bodies. Others include the use of laser and microdebrider in airway surgery. Experience with bronchoscope during the COVID-19 pandemic has been included in this review. PubMed was searched for articles on pediatric bronchoscopy, including rigid bronchoscopy as well as interventional bronchoscopy with a focus on reviewing literature in the past 5 years.Expert opinion: As the proficiency of pediatric interventional pulmonologists continues to grow more interventions are being performed. There is a scarcity of published evidence in this field. Courses for pediatric interventional bronchoscopy need to be developed. The COVID-19 experience resulted in safer bronchoscopy practice for all involved.
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Affiliation(s)
- P Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - P Pohunek
- Division of Pediatric Respiratory Diseases, Pediatric Department, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - E Eber
- Department of Paediatrics and Adolescent Medicine, Head, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, Graz, Austria
| | - F Midulla
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - G Di Mattia
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - M Merven
- Department Otorhinolaryngology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - J T Janson
- Department of Surgical Sciences, Division of Cardio-Thoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
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Anderson KR, Villafranco N, Hatzenbuehler Cameron L, Schallert EK, Joshi-Patel A, Arrington A, Dean A. A 16-Year-Old Boy With Cough and Fever in the Era of COVID-19. Pediatrics 2021; 147:peds.2020-008235. [PMID: 32788269 DOI: 10.1542/peds.2020-008235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
A 16-year-old white boy with a history of chronic lung disease of prematurity, cough-variant asthma, and incidental lung nodules presented to the emergency center in spring 2020 with acute onset dry cough, shortness of breath, and fever. An initial history, gathered from his mother because of the patient's respiratory distress, revealed no recent travel. However, his mother is a health care worker at a hospital, and sick contacts included ongoing contact with a friend with cold-like symptoms. He had a variety of animals at home, including a dog, cats, fish, rodents, and reptiles. He had a history of vaping tobacco products >6 months ago. Fever and respiratory symptoms were associated with fatigue, chest tightness, abdominal pain, and myalgias. On examination, he was ill appearing and had tachycardia, tachypnea, borderline hypoxia with an oxygen saturation of 91% on room air, diminished breath sounds at the lung bases, and unremarkable abdominal examination results. A chest radiograph was consistent with the lung examination, revealing bilateral lower lobe hazy infiltrates. He showed initial improvement for 48 hours with antibiotics, intravenous fluid resuscitation, oxygen via nasal cannula, albuterol, and prednisone. Subsequently, he worsened with persistent high fever, increasing respiratory distress with pulmonary findings, and severe persistent epigastric pain, which added a layer of diagnostic complexity. As this patient's clinical course evolved and further history became available, pulmonary medicine and infectious diseases services were consulted to guide diagnostic evaluation and treatment of this patient early in the era of coronavirus disease 2019.
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Affiliation(s)
- Kelsey R Anderson
- Baylor College of Medicine, Houston, Texas; and.,Texas Children's Hospital, Houston, Texas
| | - Natalie Villafranco
- Baylor College of Medicine, Houston, Texas; and.,Texas Children's Hospital, Houston, Texas
| | | | - Erica K Schallert
- Baylor College of Medicine, Houston, Texas; and.,Texas Children's Hospital, Houston, Texas
| | - Ashley Joshi-Patel
- Baylor College of Medicine, Houston, Texas; and.,Texas Children's Hospital, Houston, Texas
| | - Amy Arrington
- Baylor College of Medicine, Houston, Texas; and.,Texas Children's Hospital, Houston, Texas
| | - Andrea Dean
- Baylor College of Medicine, Houston, Texas; and .,Texas Children's Hospital, Houston, Texas
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Eroglu-Ertugrul NG, Yalcin E, Oguz B, Ocal T, Kuskonmaz B, Emiralioglu N, Dogru-Ersoz D, Ozcelik U, Tezcan I, Kiper N. The value of flexible bronchoscopy in pulmonary infections of immunosuppressed children. CLINICAL RESPIRATORY JOURNAL 2019; 14:78-84. [PMID: 31710418 PMCID: PMC7162225 DOI: 10.1111/crj.13103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/30/2019] [Accepted: 10/30/2019] [Indexed: 11/28/2022]
Abstract
Objectives To demonstrate the value of flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) when determining causes of lung infection in immunocompromised children; to investigate differences in causes and radiological features of lung infections following bone marrow transplantation (BMT) compared to other immunosuppressive conditions; to evaluate the reliability of radiological findings when predicting the pathogen. Methods We retrospectively evaluated 132 immunosuppressed children who underwent FB and BAL because pulmonary complications between January 1999 and May 2014 at the Hacettepe University Hospital Pediatric Pulmonology Unit. Two groups, Group I (n = 106) and Group II (n = 26), consisted of patients who had primary or secondary immunodeficiency and those who were immunosuppressed because BMT, respectively. Radiological findings before FB and macroscopic and microscopic findings of the procedure were evaluated. Results FB and BAL were diagnostic in 86/132 patients (65.1%) and the antimicrobial treatment changed for 75/132 patients (56.8%). The most common pathogen was bacteria (Streptococcus pneumoniae was the leading one). Bacteria were more frequent in Group I than Group II (P = .008). No significant difference in radiological findings between Groups I and II was found. Considering all patients, a significant association was detected between viral pathogens and radiologically interstitial infiltration and a ground‐glass appearance (P = .003). However, no significant association was detected between bacterial and fungal pathogens and the radiological findings. Conclusion In immunosuppressed patients, FB and BAL should be evaluated early for clarifying the causative agents. Then, appropriate treatments can be utilised and the side effects and high cost of unnecessary treatment may be mitigated.
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Affiliation(s)
| | - Ebru Yalcin
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Turgay Ocal
- Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Baris Kuskonmaz
- Division of Pediatric Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Dogru-Ersoz
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ilhan Tezcan
- Division of Pediatric Immunology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Kerris EJ, Patregnani JT, Sharron M, Sochet AA. Use of the pediatric intensive care unit for post-procedural monitoring in young children following microlaryngobronchoscopy: Impact on resource utilization and hospital cost. Int J Pediatr Otorhinolaryngol 2018; 115:1-5. [PMID: 30368366 DOI: 10.1016/j.ijporl.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/01/2018] [Accepted: 09/12/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the frequency of post-procedural complications, medical interventions, and hospital costs associated with microlaryngobronchoscopy (MLB) in children prophylactically admitted for pediatric intensive care unit (PICU) monitoring for age ≤ 2 years. METHODS We performed a single-center, retrospective, descriptive study within a 44-bed PICU in a stand-alone, tertiary, pediatric referral center. Inclusion criteria were age ≤2 years and pre-procedural selection of prophylactic PICU monitoring after MLB between January 2010 and December 2015. Children were excluded for existing tracheostomy, if undergoing concurrent non-otolaryngeal procedures, or if intubated at the time of PICU admission. Primary outcomes were the development of major and minor procedural complications and medical rescue interventions. Secondary outcomes were hospital cost and length of stay (LOS). RESULTS One hundred and eight subjects met inclusion criteria with a median age of 5.3 (IQR: 2.6-10.9) months. A majority (86%) underwent therapeutic instrumentation in addition to diagnostic MLB. There were no observed major complications or rescue interventions. Minor complications were noted within 5 h of monitoring and included isolated stridor (24%), desaturation <90% (10%), and nausea/emesis (8%). Minor interventions included supplemental oxygen via regular nasal cannula (39%), single-dose inhaled racemic epinephrine (19%), single-dose systemic corticosteroids (19%), or high flow nasal cannula (HFNC) therapy (4%). Save for two cases of HFNC, interventions were completed or discontinued within 5 h. Median PICU LOS was 1.1 days and median cost was $9650 (IQR: $8235- $14,861) per encounter. Estimated cost of same day observation in our post anesthesia care unit (PACU) following MLB without PICU admission is $1921 per encounter. CONCLUSIONS In children ≤ 2 years of age prophylactically admitted for PICU observation, we did not observe severe complications or major interventions after MLB. Minor interventions and complications were noted early during post-procedural monitoring. PICU monitoring was substantially more expensive than same-day PACU observation. Young age as the sole criteria for prophylactic PICU monitoring after diagnostic or therapeutic MLB may be unjustified when comparable, cost-conscious care can be achieved in a PACU setting. Prior to pre-procedural selection of PICU monitoring, we recommend a broad contextual risk assessment including a review of comorbidities, operative plan, and intended anesthetic exposure.
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Affiliation(s)
- Elizabeth J Kerris
- Pediatric Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, Children's National Health System, 111 Michigan Ave NW, Suite M4811, Washington, DC, 20010, USA.
| | - Jason T Patregnani
- Pediatric Cardiac Intensive Care Medicine, Department of Medicine Division of Cardiac Intensive Care Medicine, Children's National Health System, 111 Michigan Ave NW, Suite M4811, Washington, DC, 20010, USA.
| | - Matthew Sharron
- Pediatric Critical Care Medicine, Department of Medicine, Division of Critical Care Medicine, Children's National Health System, 111 Michigan Ave NW, Suite M4811, Washington, DC, 20010, USA.
| | - Anthony A Sochet
- Anesthesiology and Critical Care Medicine, Department of Medicine, Division of Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital, Johns Hopkins University, 501 6th Street South, OCC Suite 702, Room 709, St. Petersburg, FL, 33701, USA.
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Trachsel D, Hammer J. CPAP to diagnose laryngeal clefts by flexible endoscopy in infants. Pediatr Pulmonol 2018; 53:1284-1287. [PMID: 29971952 DOI: 10.1002/ppul.24117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/18/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Laryngeal clefts (LC) are uncommon but important causes of stridor in infants. Direct laryngoscopy is the recommended method for the detection of LC because LC may be missed by flexible endoscopy. As laryngomalacia by far outnumbers any other cause of stridor in this age group flexible bronchoscopy is usually the preferred method for the evaluation of significant infantile stridor. The aim is to illustrate how the application of CPAP assists the detection of LC during flexible endoscopy. METHOD Continuous positive airway pressure (CPAP) is applied via endoscopy mask during flexible endoscopy, titrated to open the upper esophageal sphincter, and to spread the inter-arytenoid folds. RESULTS The application of CPAP of 10-15 cmH2 O resulted in visual unmasking of otherwise obscured LC in four young children assessed for congenital stridor. CONCLUSION CPAP helps visualize LC by flexible endoscopy obviating transition to direct laryngoscopy and manual exploration.
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Affiliation(s)
- Daniel Trachsel
- Division of Intensive Care and Pulmonology, University of Basel Children's Hospital UKBB, Basel, Switzerland
| | - Jürg Hammer
- Division of Intensive Care and Pulmonology, University of Basel Children's Hospital UKBB, Basel, Switzerland
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Li X, Wang X, Jin S, Zhang D, Li Y. The safety and efficacy of dexmedetomidine-remifentanil in children undergoing flexible bronchoscopy: A retrospective dose-finding trial. Medicine (Baltimore) 2017; 96:e6383. [PMID: 28296782 PMCID: PMC5369937 DOI: 10.1097/md.0000000000006383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Flexible bronchoscopy is more and more used for diagnosis and management of various pulmonary diseases in pediatrics. As poor coordination of children, the procedure is usually performed under general anesthesia with spontaneous or controlled ventilation to increase children and bronchoscopists' safety and comfort. Previous studies have reported that dexmedetomidine (DEX) could be safely and effectively used for flexible bronchoscopy in both adulate and children. However, there is no trial to evaluate the dose-finding of safety and efficacy of dexmedetomidine-remifentanil (DEX-RF) in children undergoing flexible bronchoscopy.The objective of this study is to evaluate the dose-finding of safety and efficacy of DEX-RF in children undergoing flexible bronchoscopy.One hundred thirty-five children undergoing flexible bronchoscopy with DEX-RF were divided into 3 groups: Group DR1 (n = 47, DEX infusion at 0.5 μg·kg for 10 minutes, then adjusted to 0.5-0.7 μg kg h; RF infusion at 0.5 μg kg for 2 minutes, then adjusted to 0.05-0.2 μg kg min), Group DR2 (n = 43, DEX infusion at 1 μg kg for 10 minutes, then adjusted to 0.5-0.7 μg kg h; RF infusion at 1 μg kg for 2 minutes, then adjusted to 0.05-0.2 μg kg min), Group DR3 (n = 45, DEX infusion at 1.5 μg kg for 10 minutes, then adjusted to 0.5-0.7 μg kg h; RF infusion at 1 μg kg for 2 minutes, then adjusted to 0.05-0.2 μg kg min). Ramsay sedation scale of the 3 groups was maintained 3. Anesthesia onset time, total number of intraoperative children movements, hemodynamics (heart rate, arterial pressure, pulse oxygen saturation (SpO2), respiratory rate), total cumulative dose of dexmedetomidine and remifentanil, the amount of midazolam and lidocaine, time to first dose of rescue midazolam and lidocaine, postoperative recovery time, adverse events, bronchoscopist satisfaction score were recorded.Anesthesia onset time was significantly shorter in DR3 group (14.23 ± 5.45 vs 14.45 ± 5.12 vs 11.13 ± 4.51 minutes, respectively, of DR1, DR2, DR3, P = 0.003). Additionally, the perioperative hemodynamic profile was more stable in group DR3 than that in the other 2 groups. Total number of children movements during flexible bronchoscopy was higher in DR1 group than the other 2 groups (46.81% 22/47 vs 34.88% 15/43 vs 17.78% 8/45, respectively, of DR1, DR2, DR3, P = 0.012). Total doses of rescue midazolam and lidocaine were significantly higher in DR1 and DR2 groups than that of DR3 group (P = 0.000). The time to first dose of rescue midazolam and lidocaine was significantly longer in DR3 group than DR1 and DR2 groups (P = 0.000). Total cumulative dose of dexmedetomidine was more in DR2 and DR3 groups (P = 0.000), while the amount of remifentanil was more in DR1 and DR2 groups (P = 0.000). The time to recovery for discharge from the PACU was significantly shorter in DR1 group compared with the other 2 groups (P = 0.000). Results from bronchoscopist satisfaction score showed significantly higher in DR2 and DR3 groups than that of DR1 group (P = 0.025). There were significant differences among the 3 groups in terms of the overall incidence of hypertension, tachycardia, hypoxemia, and cough (P < 0.05).Though it required longer recovery time, high dose of DEX-RF, which provided better stable hemodynamic profiles and bronchoscopist satisfaction score, less amount of rescue scheme, and children movements, could be safely and efficacy used in children undergoing flexible bronchoscopy.
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Affiliation(s)
- Xia Li
- Department of Pathology and Pathophysiology, Binzhou Medical University, Binzhou
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Xue Wang
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Shuguang Jin
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Dongsheng Zhang
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Yanuo Li
- Department of Pathology and Pathophysiology, Binzhou Medical University, Binzhou
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Webster I, Goussard P, Gie R, Janson J, Rossouw G. The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV. Expert Rev Respir Med 2017; 11:159-165. [PMID: 28107788 DOI: 10.1080/17476348.2017.1280397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Bronchoscopy, an important investigation for the diagnosis and management of respiratory diseases, is widely used in high income countries. There is limited information on value of paediatric bronchoscopy in low and middle income countries (LMIC). AIMS AND OBJECTIVES Aim was to describe the indications, findings and complications of bronchoscopy in a middle income country with a high prevalence of tuberculosis and HIV. METHODOLOGY A retrospective analysis of a database over a 3.5 year period. RESULTS A total of 509 bronchoscopies were performed on neonates (2.3%) and children (median age = 18 months) of which 5.1% were HIV-infected. The main indications were: possible large airway compression 40%, complicated pneumonia (25%) and persistent stridor (15%). Pathology was observed in 64% of bronchoscopies. The most findings were lymph node compression of the airways (21%), and upper airway pathology (12%). Interventional procedures were performed in 112 cases (22%), the commonest being foreign bodies removal (30%), endobronchial lymph node enucleation (30%) and transbronchial needle aspiration (20%). No major complications. CONCLUSION The diagnostic yield of paediatric bronchoscopy did not differ from high income countries emphasising the importance of paediatric bronchoscopy in the management of childhood lung disease in LMICs.
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Affiliation(s)
- Irwin Webster
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Children's Hospital , Cape Town , South Africa
| | - Pierre Goussard
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Children's Hospital , Cape Town , South Africa
| | - Robert Gie
- a Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Children's Hospital , Cape Town , South Africa
| | - Jacques Janson
- b Department of Cardio-Thoracic Surgery, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Children's Hospital , Cape Town , South Africa
| | - Gawie Rossouw
- b Department of Cardio-Thoracic Surgery, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Children's Hospital , Cape Town , South Africa
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Nicolai T, Schramm D, Hammer J, Eber E, Eich CB, Hinrichs B. Bronchoskopie bei Kindern. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0046-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Terkawi RS, Altirkawi KA, Terkawi AS, Mukhtar G, Al-Shamrani A. Flexible bronchoscopy in children: Utility and complications. Int J Pediatr Adolesc Med 2016; 3:18-27. [PMID: 30805463 PMCID: PMC6372410 DOI: 10.1016/j.ijpam.2015.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 12/02/2022]
Abstract
Background and objectives The flexible bronchoscope has become widely used by pediatric pulmonologists as a diagnostic and therapeutic tool. Nevertheless, there are several gaps in our knowledge to help refine its use and reduce its complications. In this study, we aimed to evaluate the utility and complications of pediatric bronchoscopy. Design and setting We conducted a retrospective review of bronchoscopy cases between March 2006 and April 2015 at a tertiary care medical center (King Fahad Medical City). One-hundred forty nine patients were studied. Patients and methods We evaluated how bronchoscopy contributed to the patients' diagnosis, assessed the accuracy of bronchoalveolar lavage white blood cell count (BAL WBC) to differentiate between infectious and non-infectious conditions, assessed the ability of clinical factors to predict high risk of desaturation during bronchoscopy, and finally summarized the reported procedural complications. Results We found pediatric bronchoscopy was a crucial diagnostic (confirming, ruling out, and discovering unexpected diagnosis) and therapeutic tool. The accuracy of BAL WBC counts is poor (AUC (95% CI) = 0.609 (0.497–0.712)); however, using two cutoff values (≤10 WBCs (sensitivity = 84.44% and specificity = 29.27%) to rule out, and ≥400 WBCs (sensitivity = 33.33% and specificity 81.49%) to rule in infection) helped in early differentiation between infectious and non-infectious conditions. From the factors that we test, none we found predictive of desaturation. The most common procedural complication was desaturation (pooled incidence (95% CI) = 13 (8–19)%) followed by cough, mild airway bleeding, and spasm. Conclusions Flexible bronchoscopy is an important and relatively safe diagnostic and therapeutic tool in pediatric medicine, and utilization of this service should be encouraged after a careful consideration of which patient needs this procedure and a rigorous estimate of its pros and cons.
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Affiliation(s)
- Rayan S Terkawi
- Department of Surgery, Sanad Hospital, Riyadh, Saudi Arabia.,Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Abdullah S Terkawi
- Department of Anaesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.,Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Gawahir Mukhtar
- Department of Pediatric Pulmonology, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al-Shamrani
- Department of Pediatric Pulmonology, Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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Fiberoptic bronchoscopy findings in children with stridor in a tertiary hospital. Arch Bronconeumol 2015; 52:335-6. [PMID: 26548504 DOI: 10.1016/j.arbres.2015.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 11/20/2022]
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15
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de Benedictis FM, de Benedictis D, Mirabile L, Pozzi M, Guerrieri A, Di Pillo S. Ground zero: not asthma at all. Pediatr Allergy Immunol 2015; 26:490-6. [PMID: 26059018 DOI: 10.1111/pai.12421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2015] [Indexed: 12/13/2022]
Abstract
Upper airway obstruction is commonly misdiagnosed as asthma. We report on four children with recurrent respiratory symptoms who had been erroneously diagnosed as having asthma and who received anti-asthma medication for several years. The evaluation of spirometry tracing was neglected in all cases. Subglottic stenosis, tracheomalacia secondary to tracheo-esophageal fistula, double aortic arch, and vocal cord dysfunction were suspected by direct inspection of the flow-volume curves and eventually diagnosed. The value of clinical history and careful evaluation of spirometry tracing in children with persistent respiratory symptoms is critically discussed.
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Affiliation(s)
| | | | - Lorenzo Mirabile
- Department of Paediatric Anesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy
| | - Marco Pozzi
- Department of Cardiovascular Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy
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Faro A, Wood RE, Schechter MS, Leong AB, Wittkugel E, Abode K, Chmiel JF, Daines C, Davis S, Eber E, Huddleston C, Kilbaugh T, Kurland G, Midulla F, Molter D, Montgomery GS, Retsch-Bogart G, Rutter MJ, Visner G, Walczak SA, Ferkol TW, Michelson PH. Official American Thoracic Society Technical Standards: Flexible Airway Endoscopy in Children. Am J Respir Crit Care Med 2015; 191:1066-80. [DOI: 10.1164/rccm.201503-0474st] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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