1
|
Thomas RJ, Yerkovich ST, Goyal V, Chang AB, Rutter C, Masters IB, Marchant JM. The utility of elective flexible bronchoscopy to improve quality of life and clinical outcomes for children: A systematic review. Pediatr Pulmonol 2024; 59:1589-1595. [PMID: 38411339 DOI: 10.1002/ppul.26940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there is limited evidence regarding the utility of elective FB in children. This systematic review (SRs) aimed to determine the utility of FB on its impact in clinical decision making and quality of life (QoL). METHODS We searched Pubmed, Cochrane central register of controlled trials, Embase, World Health Organization Clinical Trials Registry Platform and Cochrane database of SRs from inception to April 20, 2023. We included SRs and randomized controlled trials (RCTs) that used parallel group design (comparing use of elective FB vs. no FB, or a wait-list approach [early FB vs. usual wait FB]) in children aged ≤ 18 years. Our protocol was prospectively registered and used Cochrane methodology for systemic reviews of interventions. RESULTS Our search identified 859 articles; 102 duplicates were removed, and 753 articles were excluded by title and abstract. Four full text articles were reviewed and subsequently excluded, as none met the inclusion criteria outlined in our patient, intervention, comparator, outcome measures framework. CONCLUSIONS There is a paucity of high-quality RCT evidence to support the routine use of elective FB in children with respiratory conditions. However, available retrospective and a single prospective study demonstrate the high utility of FB in the elective pediatric setting. REGISTRATION PROSPERO CRD42021291305.
Collapse
Affiliation(s)
- Rahul J Thomas
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Departments of Paediatrics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Cameron Rutter
- Academic Division, Library, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
Thomas R, Marchant JM, Goyal V, Masters IB, Yerkovich ST, Chang AB. Clinical utility of elective paediatric flexible bronchoscopy and impact on the quality of life: protocol for a single-centre, single-blind, randomised controlled trial. BMJ Open Respir Res 2024; 11:e001704. [PMID: 38413121 PMCID: PMC10900573 DOI: 10.1136/bmjresp-2023-001704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there are no randomised controlled trials (RCTs) that have examined its benefits (or otherwise).Our primary aim is to determine the impact of FB on the parent-proxy quality-of-life (QoL) scores. Our secondary aims are to determine if undertaking FB leads to (a) change in management and (b) improvement of other relevant patient-reported outcome measures (PROMs). We also quantified the benefits of elective FB (using 10-point Likert scale). We hypothesised that undertaking elective FB will contribute to accurate diagnosis and therefore appropriate treatment, which will in turn improve QoL and will be deemed to be beneficial from patient and doctor perspectives. METHODS AND ANALYSIS Our parallel single-centre, single-blind RCT (commenced in May 2020) has a planned sample size of 114 children (aged <18 years) recruited from respiratory clinics at Queensland Children's Hospital, Brisbane, Australia. Children are randomised (1:1 concealed allocation) within two strata: age (≤2 vs >2 years) and indication for FB (chronic cough vs other indications) to either (a) early arm (intervention where FB undertaken within 2 weeks) or (b) delayed (control, FB undertaken at usual wait time). Our primary outcome is the difference between groups in their change in QoL at the T2 timepoint when the intervention group has had the FB and the control group has not. Our secondary outcomes are change in management, change in PROMs, adverse events and the Likert scales. ETHICS AND DISSEMINATION The human research ethics committee of the Queensland Children's Hospital granted ethical clearance (HREC/20/QCHQ/62394). Our RCT is conducted in accordance with Good Clinical Practice and the Australian legislation. Results will be disseminated through conference presentations, teaching avenues, workshops, websites and publications. REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12620000610932.
Collapse
Affiliation(s)
- Rahul Thomas
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
| | - Anne B Chang
- Respiratory Medicine, Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
| |
Collapse
|
3
|
Elbahlawan L, McArthur J, Morin CE, Abdelhafeez H, McCarville MB, Ruiz RE, Srinivasan S, Qudeimat A. Pulmonary Complications in Children Following Hematopoietic Cell Transplantation: A Case Report and Review of the Diagnostic Approach. Front Oncol 2021; 11:772411. [PMID: 34820335 PMCID: PMC8606675 DOI: 10.3389/fonc.2021.772411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/20/2021] [Indexed: 12/24/2022] Open
Abstract
Pulmonary complications are common in children following hematopoietic cell transplantation (HCT) and contribute to their morbidity and mortality. Early diagnosis is essential for management and prevention of progression of lung injury and damage. In many cases, diagnosis can be challenging and may require diagnostic imaging and more invasive testing such as bronchoscopy and lung biopsy. We report the case of a 12-year-old girl who developed recurrent episodes of acute respiratory failure requiring intensive care unit admission in the post-HCT phase and describe the diagnostic and multidisciplinary approach for her management. In addition, we review the diagnostic approach of pulmonary complications post-HCT and highlight the utility and risks of bronchoscopy and lung biopsy in these children.
Collapse
Affiliation(s)
- Lama Elbahlawan
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jenny McArthur
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Cara E Morin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Hafeez Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Robert E Ruiz
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Saumini Srinivasan
- Division of Pulmonary, University of TN Health Science Center (UTHSC), Memphis, TN, United States
| | - Amr Qudeimat
- Department of Bone Marrow Transplant and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States
| |
Collapse
|
4
|
Mantadakis E. Pneumocystis jirovecii Pneumonia in Children with Hematological Malignancies: Diagnosis and Approaches to Management. J Fungi (Basel) 2020; 6:jof6040331. [PMID: 33276699 PMCID: PMC7761543 DOI: 10.3390/jof6040331] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
Abstract
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection that mostly affects children with suppressed cellular immunity. PJP was the most common cause of infectious death in children with acute lymphoblastic leukemia prior to the inclusion of cotrimoxazole prophylaxis as part of the standard medical care in the late 1980s. Children with acute leukemia, lymphomas, and those undergoing hematopoietic stem cell transplantation, especially allogeneic transplantation, are also at high risk of PJP. Persistent lymphopenia, graft versus host disease, poor immune reconstitution, and lengthy use of corticosteroids are significant risk factors for PJP. Active infection may be due to reactivation of latent infection or recent acquisition from environmental exposure. Intense hypoxemia and impaired diffusing capacity of the lungs are hallmarks of PJP, while computerized tomography of the lungs is the diagnostic technique of choice. Immunofluorescence testing with monoclonal antibodies followed by fluorescent microscopy and polymerase chain reaction testing of respiratory specimens have emerged as the best diagnostic methods. Measurement of (1-3)-β-D-glucan in the serum has a high negative predictive value in ruling out PJP. Oral cotrimoxazole is effective for prophylaxis, but in intolerant patients, intravenous and aerosolized pentamidine, dapsone, and atovaquone are effective alternatives. Ιntravenous cotrimoxazole is the treatment of choice, but PJP has a high mortality even with appropriate therapy.
Collapse
Affiliation(s)
- Elpis Mantadakis
- Department of Pediatrics, Hematology/Oncology Unit, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68 100 Alexandroupolis, Thrace, Greece
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|