Etiological diagnosis and treatment of bronchoscopy in pediatric intensive care unit / 中国小儿急救医学

Children in the pediatric intensive care unit who continue to have ventilator-assisted breathing are often difficult to get off-line due to respiratory system disease, cardiovascular system disease, nervous system disease, nutritional status, genetic metabolism, abnormal diaphragm movement and other factors.Through the diagnosis and treatment of flexible bronchoscope, the etiology could be identified, the ventilation function is effectively improved, and the cure rate of weaning difficulty increases.This paper discussed the etiological diagnosis and treatment of flexible bronchoscopy in children with difficulty in weaning from pediatric intensive care unit.

Diagnosis and treatment of necrotizing pneumonia in 32 children with flexible bronchoscopy / 中国实用儿科杂志

OBJECTIVE: To evaluate the diagnostic and therapeutic value of flexible bronchoscopy in children with necro⁃tizing pneumonia. METHODS: Clinical data of children diagnosed with necrotizing pneumonia in the Department of Pedi⁃atrics of the First Hospital of Jilin University from December 2016 to December 2017 were collected. The general clini⁃cal manifestations,laboratory examination results,chest X-ray or lung CT,flexible bronchoscope and other examinations of all the children were analyzed retrospectively. Based on the characteristics,diagnosis,treatment and prognosis,the ad⁃vantages of flexible bronchoscopy in this disease were analyzed. RESULTS: All the 32 cases were diagnosed as necrotizing pneumonia by imaging examination,with an average diagnosis time of 14.1 d. All 32 cases of children with necrotizing pneumonia received flexible bronchoscopy and alveolar lavage. The alveolar lavage in 32 cases presented turbidity mito⁃ta-like changes,which had high sensitivity in the diagnosis of necrotizing pneumonia. The average time for mitota-like changes in alveolar lavage was 6.7 days. CONCLUSION: Flexible bronchoscopy is an important method in the diagnosis and treatment of necrotizing pneumonia,and the change of alveolar lavage fluid is a sensitive index for early prediction of necrotizing pneumonia.

Outcome of pediatric non resolving pneumonias with the aid of pediatric flexible bronchoscopy

Background: Studies are required to establish the utility and safety of use of the procedure of the flexible bronchoscopy under various circumstances and the various settings. Aim: To study outcome of pediatric non resolving pneumonias with the aid of pediatric flexible bronchoscopy Material and Methods: Present study was hospital based prospective study. We selected 100 cases in 1 year to 8 years age group, with radiological features persisting after 3 weeks of optimal antibiotics, their sputum for AFB, and gastric lavage for AFB was negative, sputum culture was sterile. We did pediatric flexible bronchoscopy (Olympus BF3C30, outer diameter of 3.2 mm), under short general anesthesia. All the procedures were uneventful, no reported morbidity or mortality after the procedure, Followed after the procedure till radiological shadows disappear. Results: The most common finding of the flexible bronchoscopy was normal airway anatomy – with thick mucopurulent secretions was found in 55% of the cases. In the normal airway anatomy – with thick mucopurulent secretions, 20 showed TB gene positive. In the normal airway anatomy with thick mucus plug obstructing total lumen of affected air way was sterile in all 18 cases. Foreign body impacted in bronchus in 12 cases. Mediastinal lymph node compressing main stem bronchus was identified in 6 cases. Conclusion: Paediatric flexible bronchoscopy is very useful investigation in non-resolving pneumonias.

Bronchoscopic management of benign bronchial stenosis by electrocautery and balloon dilatation.

Benign bronchial stenosis is managed by surgical or bronchoscopic methods. Although surgical approach is definitive, it is technically demanding and is costlier than bronchoscopic treatment. Here, we report the case of a 27-year-old female patient with symptomatic benign bronchial stenosis of the left main bronchus. The stenosis was dilated successfully through a fibreoptic bronchoscope by electrocautery followed by balloon bronchoplasty and application of mitomycin-C. On follow up, there was no evidence of re-stenosis.

Clinical Features of Tracheobronchial Foreign Bodies in Adults according to the Risk of Aspiration / 결핵및호흡기질환

BACKGROUND: We wanted to examine the clinical characteristics of adult patients with tracheobronchial foreign bodies (FBs) according to the risk of aspiration and the outcomes of intervention with using a fiberoptic bronchoscope. METHODS: From December 1994 through December 2004 at Kyung Hee Medical Center, we retrospectively analyzed the medical records of 29 adult patients with FBs that were identified by using a fiberoptic bronchoscope. RESULTS: 14 patients were not at risk of aspiration, whereas 15 had cerebrovascular diseases and they were at a high risk of aspiration. No history suggestive of FB aspiration was noted in 7 (24.1%) patients. Respiratory symptom(s) were noted in 22 patients, and these symptoms were cough (62.0%), dyspnea (44.8%), fever (20.7%), wheezing (13.8%), chest pain (10.3%) and hemoptysis (0.4%). Only 60% of those patients at a high risk of aspiration had symptom(s) (92.8% of those patients without a risk of aspiration had symptoms, p=0.005). Those patients at risk for aspiration had a longer duration of symptoms (median: 4 days vs. 2 days for those patients not at risk for aspiration, p=0.007) before diagnosis. Acute respiratory symptom(s) within 3 days after aspiration were more frequent in the patients without a risk of aspiration (9 vs. 4, respectively p=0.048). Chest x-ray revealed radiological abnormalities in 23 patients, and these were opacities suspicious of FB (n=11), pneumonia (n=8), air trapping (n=5) and atelectasis (n=3). There were no differences in radiological findings according to the risk of aspiration. FB aspiration developed most commonly during medical procedures (57.1% for the patients at risk) and during eating (35.7% for the patients without risk). The most common FB materials were teeth (n = 11). Alligator jaw biopsy forceps (n = 23) was the most commonly used equipment. All of the FBs were removed without significant complications. CONCLUSION: This study underlines that a tracheobronchial FB in the patients who are at a high risk of aspiration are more likely to overlooked because of the more gradual onset of symptoms and the symptoms develop iatrogenically in many cases.

Analysis of diagnosis and management of children with foreign bodies in the larynx and trachea / 中华急诊医学杂志

0.5). However, when the flexible bronchoscope was used, foreign bodies dropped into the esophagus in 5 patients. Conclusion The characteristic manifestations was not frequent in the patients with larynx and trachea foreign bodies.History of aspiration was the most sensitive diagnostic tool. The plain chest radiography and fluoroscopy had low positive finding.Therefore, fiberoptic bronchoscopic examination should be performed timely.However, for extraction of foreign bodies, rigid bronchoscope would be the first choice.

A Case of RUL Bronchopleural Fistula Occluded by Flexible Bronchoscope with Endobronchial Watanabe Spigot (EWS) / 결핵및호흡기질환

An 86 year old woman was admitted complaining of dyspnea and right pleuritic pain with a 5 week durations. A physical examination, chest X-ray, and diagnostic thoracentesis upon admission revealed findings consistent with severe pneumonia and empyema on the right lung. Despite the insertion of a chest tube and negative suction via Emersion pump, the continuous air leakage was sustained, and a bronchopleural fistula (BPF) was found on the chest-CT. A flexible bronchoscopic occlusion with an Endobronchial Watanabe Spigot (EWS) was performed after 56 days of admission. An 5 mm diameter EWS was successfully inserted into the anterior segmental bronchus of the right upper lobe by flexible bronchoscope. There was no aAir leakage detected after this procedure. The patient was discharged 30 days after the EWS occlusion.