Role and Impact of Flexible Fiberoptic Bronchoscopy in Critically Ill Children: A Prospective Observational Study

Background: The most common issue in pediatric and neonatal intensive care units (PICUs and NICUs) is pulmonary diseases. In this group, safe, accurate diagnosis and bedside treatment are essential. Fiberoptic bronchoscopy is being used more often in the treatment of critically sick patients due to its diagnostic and therapeutic benefits as well as its proven safety. Objective: This study aimed to determine the diagnostic and therapeutic value of flexible fiberoptic bronchoscope in critical children. Patients and methods: A prospective study was conducted on 32 children aged 1 month–12 years who were admitted to the PICU at Abo El Rish Children’s Hospital, Cairo University. Clinical data, indications, findings, and outcomes following flexible fiberoptic bronchoscopy (FFB) were analysed.
Results: The main indications for FFB were persistent pulmonary infiltrates (54.8%), difficult extubation (19.4%), and stridor or wheeze (19.4%). FFB yielded diagnostic or therapeutic information in 90% of cases; 71% were diagnostic, and 29% were therapeutic. Common findings were airway inflammation (32%) and mucus plugging (29%). Bronchoalveolar lavage (BAL) demonstrated 100% sensitivity compared to blood cultures in detecting infection. Patients under two years showed shorter ventilation duration and lower mortality (p=0.07).
Conclusion: Flexible fiberoptic bronchoscopy is a crucial and safe treatment for critically-ill infants and children with various respiratory conditions and considerably aiding in their care.