Pediatric Bronchoscopy

Pediatric Bronchoscopy

Bronchoscopy is an endoscopic procedure that allows direct visualization of the airways. In pediatrics, it serves both diagnostic and therapeutic purposes, providing valuable information about airway anatomy and pathology.

Key Points

  • Essential diagnostic and therapeutic tool
  • Requires specialized pediatric equipment
  • Performed under sedation/anesthesia
  • Age-specific considerations necessary
  • High safety profile with proper expertise

Types of Bronchoscopy & Equipment

Flexible Bronchoscopy

  • Most commonly used
  • Better visualization of distal airways
  • Sizes available:
    • Ultra-thin (2.2mm)
    • Standard pediatric (3.5-4.0mm)
    • Adult size (4.9-6.0mm)
  • Advantages:
    • Less traumatic
    • Better tolerated
    • Can reach peripheral airways

Rigid Bronchoscopy

  • Used for specific interventions
  • Better for therapeutic procedures
  • Sizes: 2.5-7.0mm diameter
  • Advantages:
    • Larger working channel
    • Better control of bleeding
    • Superior airway control

Essential Equipment

  • Light source and camera system
  • Suction equipment
  • Oxygen supply
  • Monitoring devices
  • Emergency cart
  • Specimen collection materials

Indications for Bronchoscopy

Diagnostic Indications

  • Stridor evaluation
    • Congenital
    • Acquired
  • Persistent wheeze
  • Chronic cough
  • Recurrent pneumonia
  • Hemoptysis
  • Suspected foreign body
  • Airway evaluation in:
    • Tracheostomy patients
    • Intubated patients
    • Post-surgical cases

Therapeutic Indications

  • Foreign body removal
  • Mucus plug removal
  • Airway dilation
  • Laser therapy
  • Stent placement/removal
  • Bronchoalveolar lavage

Research Applications

  • Airway inflammation studies
  • Mucosal biopsy collection
  • Clinical trials

Procedure Details

Pre-procedure Assessment

  • Medical history review
  • Physical examination
  • Laboratory tests if needed
  • Imaging review
  • Fasting instructions:
    • Solids: 6 hours
    • Formula: 4 hours
    • Clear liquids: 2 hours

During the Procedure

  1. Anesthesia/Sedation
    • Type based on procedure
    • Age-appropriate dosing
    • Continuous monitoring
  2. Positioning
    • Supine position
    • Head midline
    • Neck slightly extended
  3. Bronchoscope insertion
  4. Systematic airway examination
  5. Specific interventions as needed

Post-procedure Care

  • Recovery monitoring
  • Oxygen supplementation if needed
  • Discharge criteria assessment
  • Follow-up instructions

Normal & Abnormal Findings

Normal Anatomy

  • Trachea
    • Smooth mucosa
    • C-shaped cartilage rings
    • Normal branching pattern
  • Main bronchi characteristics
  • Bronchial generation patterns
  • Mucosal appearance

Common Abnormal Findings

Finding Clinical Significance
Laryngomalacia Most common cause of stridor in infants
Tracheomalacia Dynamic airway collapse
Subglottic stenosis Narrowing below vocal cords
Foreign bodies Usually in right main bronchus

Documentation Requirements

  • Written description
  • Photo/video documentation
  • Anatomical diagrams
  • Procedure notes

Complications & Management

Minor Complications

  • Transient fever
  • Mild bleeding
  • Cough
  • Temporary stridor
  • Local trauma

Major Complications

  • Respiratory:
    • Laryngospasm
    • Bronchospasm
    • Pneumothorax
  • Cardiovascular:
    • Arrhythmias
    • Vasovagal reactions
  • Anesthesia-related

Prevention & Management

  • Proper patient selection
  • Experienced team
  • Appropriate equipment
  • Emergency preparedness
  • Close monitoring

Risk Factors

Risk Factor Management Strategy
Young age Size-appropriate equipment
Respiratory compromise Pre-procedure optimization
Bleeding disorders Coagulation correction


Further Reading
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