[Endoscopic approach to pulmonary diseases: Bronchoscopy for critical respiratory care in neonates, infants, and children].

Of the 605 pediatric patients admitted to our intensive care unit during the past 6 years, 90 underwent 380 bronchoscopies for diagnostic and therapeutic purposes. The indications for bronchoscopy were atelectasis/retention of airway secretion (n = 52), pneumonia (n = 31), airway bleeding (n = 14), pulmonary edema (n = 11), tracheobronchomalacia/airway stenosis (n = 11), and airway foreign body/aspiration (n = 7). Visualization of the airway was helpful for the diagnosis of respiratory problems; in 9 infants, bronchoscopy revealed tracheobronchial stenosis which other diagnostic modalities failed to detect. In 25 of the 31 patients with pneumonia, specimens taken by bronchoscopy were positive for specific pathogens. Bronchoscopy also proved to have significant therapeutic value, especially for airway cleaning; bronchial suctioning resulted in immediate reexpansion of the collapsed lung in 25 of 34 cases of physiotherapy-resistant atelectasis. A rigid bronchoscope was used to remove airway foreign body in 2 cases. Prototype channeled-ultrathin fiberscopes were utilized in 99 of 380 bronchoscopies. No complications were noted except for severe hypoxia and bradycardia in one infant. We conclude that bronchoscopy is a safe and useful modality for the critical respiratory care of infants and children.