INDICATIONS FOR BRONCHOSCOPY:       Stridor Unexplained or persistent wheeze Unexplained or persistent cough Unexplained hemoptysis Possible tracheobronchial foreign

body aspiration Investigation of chest radiograph abnormalities o Persistent/recurrent lobar consolidation or atelectasis o Recurrent or persistent infiltrates o Lung lesions of unknown etiology Pulmonary infection to identify pathogens o In infection unresponsive to antibiotics o In a child with cystic fibrosis to identify pathogens o In an immunosuppressed child o Recurrent infection Intensive care/anesthetic room o Examine for the position, patency or airway damage due to ET or tracheostomy tube o Facilitate difficult intubations Airway injury o Assessment of injury from toxic inhalation or aspiration Other therapeutic and diagnostic indications o Endobronchial stent placement o Sampling and/or removal of airway secretions and mucus plugs o Endobronchial and transbranchial biopsy

 

Contraindications and complications of airway endoscopy:

Complications are more likely in children with: 1. bleeding diatheses that cannot be corrected; 2. massive hemoptysis; 3. severe airway obstruction; 4. severe hypoxia; 5. pulmonary hypertension; 6. lung abscess where there is a risk of pus spreading throughout the lung if the cavity is ruptured. Anklyosis of the jaw or neck may preclude rigid bronchoscopy.
 The complications of airway endoscopy can generally be divided into : o those associated with the medications used before and during the endoscopic procedure o those related to the instrumentation

 Those related to medications: o Inadequate topical analgesia may lead to laryngospasm or other vagally mediated phenomena. o Inadequate sedation may lead to patient discomfort; alternatively, too much sedation may lead to respiratory depression and apnea. o Episodes of hypoxemia, bradycardia or apnea are common but usually transient and selflimiting.  Due to Instrumentation: o Transient high fever is common within 24 h after a bronchoalveolar lavage. o Small hemoptyses commonly follow biopsy procedures. o The risk of trauma to the oropharnyx or airway is greater with the rigid bronchoscope. o More serious problems, including laryngospasm and pneumothorax, can occur, but are rare. o Airway instrumentation may exacerbate airway narrowing in children with already compromised airways such as those with subglottic stenosis. o Nebulized adrenaline (epinephrine) or intravenous corticosteroids may help the child over but, rarely, intubation may be necessary. o The reported incidence of pneumothorax following TBB is up to 8%