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.