Chapter 56. Bronchoscopy

• • 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.

• • 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.