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  • • 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.


  • • Severe bleeding problems.

    • Severe airway stenosis.

    • Severe hypoxia.

    • Severe bronchospasm.

  • • 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 56–2.

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.

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