YIELD FROM FLEXIBLE BRONCHOSCOPY IN CHILDREN

Flexible fiberoptic (FO) bronchoscopy can now be undertaken readily in children using topical anesthesia and light sedation and has largely supplanted rigid open tube (OT) bronchoscopy for diagnostic purposes. The present study examined the contribution of the FO bronchoscope to clinical management in children presenting with specific types of prob lems. We examined the first 200 consecutive flexible bronchoscopies pe rformed in 1995 in children under 18 years of age (median age, 2.27 ye ars). Indications for bronchoscopy were noisy breathing (26.5%), recur rent pneumonia (21.0%), suspected pneumonia in an immunocompromised pa tient (10.5%), atelectasis or bronchial toilet (12.5%), possible forei gn body aspiration (13.0%), and miscellaneous other reasons (16.5%). I nspection of the airway was abnormal in 67.0% of all investigations an d made a clinically meaningful contribution to management in 67.5%, es pecially in those with noisy breathing (98.1%), possible foreign body aspiration (100%), and atelectasis (76.0%). Bronchoalveolar lavage (BA L) cytology was abnormal in 80.4% of the 107 ravages, but contributed little to management except in those with recurrent pneumonia (73.8%). Bacteria were isolated in 26.6% of the 109 specimens cultured, but th is finding rarely affected management. Fungi were isolated in 47.4% of the 19 ravages in the immunocomprised group. Together, inspection, BA L and microbiology contributed to management in a mean of 90.5% (range , 76.2-100%) of patients in the various groups. We concluded that a hi gh yield of clinically meaningful information can be expected from FO bronchoscopy in children when coupled with BAL and microbiological stu dies of ravage fluid. (C) 1997 Wiley-Liss, Inc.