Flexible bronchoscopy and bronchoalveolar lavage in pediatric patients with lung disease
Flexible bronchoscopy and bronchoalveolar lavage in pediatric patients with lung disease
复制标题
DOI：
10.1097/pcc.0b013e31819372ea
复制
发表时间：
2009-01-01
影响因子：
4.1
通讯作者：
Yahav, Yaacov
中科院分区：
文献类型：
--
作者：
Efrati, Ori;Sadeh-Gornik, Udi;Yahav, Yaacov
目的：使用可弯曲支气管镜（FOB）和支气管肺泡灌洗（BAL）检查小儿气道异常和肺浸润是不可或缺的，现在是许多中心的常规程序。免疫功能低下和癌症患者，特别是骨髓移植后，以及接受先天性心脏病（CHD）手术的儿童患肺部疾病的风险很高。我们的目的是研究诊断率，安全性和临床收益的FOB危重pediatric patients.Design：回顾性图表review.Setting：儿科重症监护病房在一所三级大学医院。患者：319名儿童谁接受了335 FOB程序。支气管镜检查的适应症包括在免疫功能正常的患者中发现新的肺部浸润（46%）和发热和中性粒细胞减少伴呼吸道症状的患者（18%）中的病原体识别，上气道阻塞（16%）、CHD（15%）和气道创伤（5%）患者的气道解剖学评价。数据通过回顾患者的病历、支气管镜检查报告和实验室检查结果获得。测量和主要结果：FOB检查的诊断率为79%。FOB和BAL导致70例患者（23.9%）的管理改变（阳性临床产率）。在56例患者（17.6%）中确定了明确的感染性微生物。癌症或原发性免疫缺陷患者的临床获益率（38.7%）显著高于冠心病（20.4%，p < 0.01）和肺炎（17%，p < 0.01）患者。在2例手术中观察到严重并发症（长时间呼吸暂停），在45例患者（14%）中观察到轻微并发症（短暂性去饱和、喘鸣和轻微出血）。FOB和BAL在评估儿童患者的气道异常和肺浸润方面具有重要作用，快速准确的诊断对生存至关重要。我们建议FOB应被视为一个初步的诊断工具，在这些危重病人。（Pediatr Crit Care Med 2009; 10：80-84）
Objective: The use of flexible bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in investigating pediatric patient with airway abnormalities and pulmonary infiltrates are indispensable and are now a routine procedure in many centers. Immunocompromised and cancer patients, especially after bone marrow transplantation, and children who have undergone surgery for congenital heart disease (CHD) are at high risk for pulmonary disease. Our aim was to study the diagnostic rate, safety, and clinical yield of FOB in critically ill pediatric patients.Design: Retrospective chart review.Setting: Pediatric intensive care unit in a tertiary university hospital.Patients: Three hundred nineteen children who underwent 335 FOB procedures. The indications for bronchoscopy included infectious agent identification in immune-competent patients with new pulmonary infiltrates seen on chest radiograph (46%) and in patients with fever and neutropenia with respiratory symptoms (18%), airway anatomy evaluation in patients with upper airway obstruction (16%), CHD (15%), and airway trauma (5%). Data were obtained by reviewing the patients' charts, bronchoscopy reports, and laboratory results.Measurements and Main Results: The diagnostic rate of FOB procedures was 79%. FOB and BAL resulted in alteration of management (positive clinical yield) in 70 patients (23.9%). A definite infectious organism was identified in 56 patients (17.6%). The clinical yield in patients with cancer or primary immune deficiency (38.7%) was significantly higher compared with patients with CHD (20.4%, p < 0.01) and pneumonia (17%, p < 0.01). Major complications were observed in two procedures (prolonged apnea), and minor complications (transient desaturation, stridor, and minor bleeding) were observed in 45 pabents (14%).Conclusions. FOB and BAL have an important role in the evaluation of airway abnormality and pulmonary infiltrate in pediatric patients, in whom rapid and accurate diagnosis is crucial for survival. We suggest that FOB should be considered as an initial diagnostic tool in those critically ill patients. (Pediatr Crit Care Med 2009; 10:80-84)