Pediatric fiberoptic bronchoscopy as adjunctive therapy in acute asthma with respiratory failure Pediatric Pulmonology, 05/25/2012

Maggi JC et al. – Flexible bronchoscopy with bronchial lavage is a safe adjunctive therapy in pediatric asthmatics with respiratory failure resulting in reduced mechanical ventilation and intensive care length of stay. Restoring lung volume in certain asthmatics during respiratory failure may be deemed beneficial.

• A chart review was performed on all pediatric intensive care unit (PICU) asthmatics with respiratory failure over 13 years.
• Forty-four patients were identified. Patients were managed per standardized guidelines for status asthmaticus with mechanical ventilation.
• Ventilator management prioritized spontaneous breathing with pressure support. Extubation criteria included spontaneous tidal volumes of 5–7cm3/kg on low-pressure support. Standard endotracheal tube pulmonary toilet were implemented.
• Twenty-nine patients underwent bronchoscopy as an adjunctive therapy. Indications for bronchoscopy included: Pathogen identification via bronchoalveolar ravage, atelectasis, mucus obstruction resulting in severe air trapping, suspected aspiration, and poor response to standard therapy.

• Bronchoscopies revealed thick mucus plugs, secretions, and bronchial casts.
• The large airways were lavaged for clearance of obstructive secretions with normal saline.
• All patients tolerated the procedure without any complications. Demonstrable improvement in pulmonary compliance was noted.
• The median time of intubation for the bronchoscopy group was 10hr compared to 20.5hr for the control group (P<0.0005).