Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Persistent atelectasis.• Stridor.• Unexplained or persistent wheeze.• Suspected foreign body.• Pneumonia (recurrent, unknown etiology, or in an immunocompromised patient).• Persistent radiographic infiltrates.• Hemoptysis (to localize area of bleeding).• Suspected congenital abnormalities.• Suspected airway obstruction or compression, including nasal obstruction or associated with sleep disordered breathing.• Unexplained or persistent cough.• Excessive bronchial secretions.• Evaluation of artificial airway (tracheostomy or endotracheal tube).• Persistent hoarseness.• Suspected vocal cord dysfunction and paralysis.• Aspiration.• Epistaxis.• Suspected airway trauma. +++ Relative + • Severe bleeding problems.• Severe airway stenosis.• Severe hypoxia.• Severe bronchospasm. + • Rigid or flexible bronchoscope (Figures 56–1 and 56–2). + • Many different size flexible bronchoscopes allow visualization in a wide range of children.• The smallest is 2.2 mm in diameter.• It can be used in premature infants and in endotracheal tubes as small as 2.5 mm; however, it does not have a suction port.• The 2.8 mm is most commonly used; it has a suction port that allows specimens to be obtained. ++Figure 56–1.Graphic Jump LocationView Full Size||Download Slide (.ppt)Rigid bronchoscope.++Figure 56–2.Graphic Jump LocationView Full Size||Download Slide (.ppt)Flexible bronchoscope. + • Must be weighed with benefits of procedure.• Information obtained through less invasive, less expensive, or safer procedures should be explored. + • The most common method for obtaining specimens of secretions from the lower airway is bronchoalveolar lavage.• The specimen can be sent to the laboratory for infectious evaluation (eg, bacterial, fungal, viral cultures) and to pathology for additional evaluation.• Lipid-laden macrophages are a common pathologic evaluation and help diagnose aspiration.• Other specimens can be obtained with various instruments passed through the suction port (eg, biopsies and brushing). + • Explain to the family what symptoms are being evaluated and describe the procedure. +++ Rigid Bronchoscopy + • Most often done with sedation or anesthesia.• Uses a stiff tube to visualize airways to about the level of the carina.• Airway has traction placed on it, allowing for improved visualization of posterior airway structures.• Major advantage is the ability to pass a variety of instruments through the tube, allowing for surgical intervention including removal of a foreign body. +++ Flexible Bronchoscopy + • Most often done with sedation or anesthesia.• Can be performed at the bedside in intensive care unit.• Introduce bronchoscope through the nasal passages or through an artificial airway, allowing the airways to be visualized without traction on airway.• This method can also be used in patients with tracheostomy.• The entire airway can be visualized, starting at the nasal passages and extending down to multiple generations of right and left bronchi. ++Table ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.