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Flexible endoscopy of paediatric airways

¹ Istituto di Clinica Pediatrica, Servizio Speciale Fibrosi cistica, Università di Roma "La Sapienza", Roma, Italy. ² Service de Pneumologie et d'allergologie pediatriques, Groupe Hospitalier Necker-Enfants malades, Paris, France. ³ Dept of Paediatrics, University of Padova, Padova, Italy. ⁴ Dept of Paediatrics, Royal Brompton Hospital, London, UK. ⁵ Universitaetsklinik fuer Kinder und Jugendheilkunde, Klinische Abteilung fuer Pulmonologie und Allergologie, Graz, Austria. ⁶ Dept of Child Health, University of Leicester, Leicester, UK. ⁷ Dept of Anaesthesia, Royal Brompton Hospital, London, UK, ⁸ Istituto di Clinica Pediatrica, Servizio Neonatologia, Università di Roma "La Sapienza", Roma, Italy. ⁹ Division of Paediatric Pulmonology, 2nd Paediatric Dept, University Hospital Motol, Praha, Czech Republic. ¹⁰ Children's Hospital, University of Essen, Essen, Germany

CORRESPONDENCE: F. Midulla, Servizio Speciale Fibrosi Cistica, Università di Roma "La Sapienza", Viale Regina Elena 324, 00161, Rome, Italy. Fax: 39 0649979266. E-mail: midulla@uniroma1.it

Keywords: bronchoalveolar lavage, children, flexible bronchoscopy, foreign body, neonatal intensive care, paediatric intensive care

Received: December 6, 2002
Accepted March 26, 2003

Abstract

Paediatric fibreoptic bronchoscopy is used for ever wider indications, and increasingly used in many contexts, including paediatric and neonatal intensive care.

The report of this Task Force contains an overview on the current applications of paediatric bronchoscopy. The report discusses the facilities and equipment needed for the procedure, including the newly developed bronchoscopes which are allowing intervention even in very small children. The indications of both flexible and rigid bronchoscopes in the context of newer and smaller flexible endoscopic equipment are also considered. The care of the instruments, including disinfection and sterilisation, is fully documented. Patient management is described, including the relative merits of conscious sedation and general anaesthesia, as well as special settings for the procedure, including the needs in intensive care.

Special procedures, increasingly performed bronchoscopically are described. These include bronchoalveolar lavage, endobronchial and transbronchial biopsy, laser therapy, bronchography, and endoscopic intubation and drug therapy. Finally, neonatal bronchoscopy is discussed, and the ethics of bronchoscopic procedures, including bronchoscopic research in children.

Advances in instrumentation, and also improved anaesthetic techniques, allow fibreoptic bronchoscopy to be safely performed in even very small, sick infants, provided proper precautions are taken.

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