Abstract
Introduction
Critically ill children treated with extracorporeal membrane oxygenation (ECMO) support frequently have respiratory complications amenable to evaluation by flexible bronchoscopy (FB). The safety and efficacy of FB in this setting has not been well described in children.
Methods
Retrospective analysis of 153 FBs in 79 children treated with ECMO at a single institution from 2000 to 2008. Demographic data, clinical findings, and complications were obtained. Chest radiographs reports were evaluated prior to and following FB. Physiologic variables were compared prior to and following FB.
Results
Seventyโnine patients underwent FB on ECMO [58 venoโvenous (VV) and 21 venoโarterial (VA) ECMO], with 153 total FBs performed. Indications for FB included clearance of tenacious airway secretions (nโ=โ118, 77%), or evaluation of suspected secondary infections with bronchoalveolar lavage (nโ=โ26, 17%). Two patients also had surfactant instillation following secretion removal. FB was performed a median 5 days following cannulation for ECMO (range 2โ14 days). Most common findings included thick secretions (nโ=โ77, 50.3%), mucoid secretions (nโ=โ15, 9.8%), and mucopurulent secretions (nโ=โ28, 18.3%). No deterioration in radiographic lung findings was described postโFB. FB was not associated with any significant change in heart rate, systemic blood pressure, or temperature. No significant changes in ECMO pump flow rate or sweep gas flow was seen during or after FB. Cannula dislodgement, inadvertent extubation, fever, pneumothorax, or intraprocedural hypoxemia was not reported. Fiftyโthree FBs (35%) resulted in bloodโtinged secretions from the endotracheal tube postโFB, which resolved spontaneously. Three patients received high frequency oscillatory ventilation (HFOV) following FB in association with mild hemorrhage.
Conclusions
FB is a wellโtolerated and safe procedure in critically ill pediatric patients on ECMO. FB may have a diagnostic as well as therapeutic benefit in such patients. Pediatr. Pulmonol. 2011; 46:1108โ1113. ยฉ 2011 Wiley Periodicals, Inc.