PubMed · 727960
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R J Clark. 1978. Indications for bronchoscopy.. https://pubmed.ncbi.nlm.nih.gov/727960/
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We reviewed 265 rigid bronchoscopies performed in 50 children with tracheotomy-dependent subglottic stenosis (25 congenital, 25 acquired). Granulomas developed in 40 children (80%) and were unrelated to age, sex, race, gastroesophageal reflux, tracheotomy duration, or type of stenosis. The incidence of small to medium, large, and obstructing granulomas at endoscopy was 28%, 6%, and 0%, respectively. Compared with a baseline finding of no granuloma at preceding bronchoscopy, the odds of granuloma recurrence were 3.0 after an unexcised granuloma (95% confidence interval [CI], 1.1 to 8.4), 4.1 after granuloma excision (95% CI, 1.4 to 11.9), and 7.3 after expansion surgery (95% CI, 1.1 to 49.2). Considering the low incidence of large or obstructing granulomas, and the failure of granuloma excision to diminish recurrence, we do not recommend interval excision of nonobstructing granulomas in children with stable tracheotomies.
Pulmonary atelectasis is often seen in young infants with respiratory disease and it may contribute to increased ventilatory requirements and the development of chronic lung disease such as bronchopulmonary dysplasia. Standard management consists of postural drainage (chest physiotherapy and suction) and selective intubation with suction of a major bronchus. This report describes a new approach consisting of removal of bronchial secretions under direct vision via ultrathin fiberoptic bronchoscopy, without interruption of mechanical ventilation. The procedure was performed safely in ten cases and resulted in significant rapid improvement in the infants' respiratory condition and in complete resolution of the atelectasis in eight cases. In two infants, partial improvement was seen. No adverse effects of the procedure were encountered. It is concluded that this approach is a safe and potentially valuable therapeutic maneuver in the management of pulmonary atelectasis in sick intubated neonates.