VALUE OF THE FIBEROPTIC BRONCHOSCOPE IN C HILDREN WITH EPIGLOTTITIS

Acute epiglottitis is an infectious disease causing a severe respirato ry distress. Any attempt to move the child in the horizontal position or to examine his throat can result in cardiac arrest. Diagnosis, endo tracheal intubation as well as decision making of the optimal time for extubation are greatly facilitated by the use of a fibreoptic broncho scope. The device is a paediatric model (external diameter 3.6 mm with an operating channel). It is inserted through the nare in the child i n the sitting position. Oxygen is delivered through a nasal tube. The examination is performed under local anaesthesia (lidocaine 0.5 %). Mi dazolam is sometimes added via the rectal or i.v. route. The clinical signs are monitored as well as the heart rate and SpO(2). The diagnosi s of epiglottitis as it is visual, is very easy and rapid once the epi glottis is observed through the fibreoptic bronchoscope. The advantage of the examination under fibreoptic bronchoscope is to allow visualiz ation without aggression or stimulation of the pharyngolaryngeal struc tures and without modification of the child's position. Endotracheal i ntubation, which is always required, is facilitated as the child is br eathing spontaneously. The expiratory flow blows bubbles of saliva, wh ich guide the bronchoscope to the glottis. When the internal diameter of the endotracheal tube is larger than 4 mm, the bronchoscope is used as a guide. When it is less than 4 mm. the bronchoscope is inserted i n the trachea with a guide wire slipped in the operating channel; the bronchoscope, but not the wire is withdrawn and the endotracheal tube is inserted over the guide wire. In our practice, intubation has alway s been possible and well tolerated in awake and seated children. Neith er haemodynamic variations nor a decrease in SpO(2) values occurred. F inally, the bronchoscope makes it possible to check the retrogression of oedema, characterized by the constitution of a gap between the epig lottis and the endotracheal tube and thus to choose the optimal time f or extubation and to shorten the intubation period. In conclusion, in case of hyperthermic inspiratory dyspnoea in a child with sialorrhea, who insists on remaining seated, a flexible fibreoptic bronchoscopy sh ould be performed first, any other examination being useless or even d angerous.