An insight into risk factors associated with procedural complications of Pediatric Flexible Bronchoscopy

Flexible bronchoscopy is a crucial diagnostic tool for children with respiratory issues but can be associated with complications. The present study was aimed to evaluate the frequency of complications during flexible bronchoscopy in children and identify associated risk factors.

The study reviewed the records from children who underwent flexible bronchoscopy at the Pediatric Pulmonology Division at AIIMS, Delhi, from May 2018 to August 2022. Children on high-flow oxygen or mechanical ventilation before the procedure were excluded. Conscious sedationusing midazolam + fentanyl or midazolam alone was mostly applied, with propofol reserved for older children.Mild complications included self-limiting mild nasal bleeds, desaturation (SpO2 ≥ 80% < 90%), and transient laryngospasm while severe complications included desaturation (SpO2 < 80%) irrespective of duration, endobronchial bleeds,bradycardia, apnea requiring positive pressure ventilation, respiratory depression, and cardiopulmonary arrest.

The study demonstrated the following findings:

·        The study included 869 bronchoscopies in children under 18 years, with a median age of 24 months.

·        Complications occurred in 6.7% of the procedures; 4.7% were, and 3.2% were severe.

·        Severe complications led to procedure abortion and required resuscitative measures, with some children admitted to intensive care for monitoring.

·        Bivariate and multivariate logistic regression analyses identified age under 1 year, recurrent respiratory papillomatosis, and lower airway malacia as significant independent risk factors for complications.

·        Sedation choice did not significantly affect complication rates, and propofol was noted to be safe in older children.

To summarize, the study offers avaluable understanding into the safety of flexible bronchoscopy in pediatric patients, highlighting specific risk factors to help minimize complications.

Source: Manoharan A, Jat KR, Dhochak N, Lodha R, Sankar J. Risk Factors for Procedural Complications of Pediatric Flexible Bronchoscopy: Experience From a Tertiary Care Centre in Northern India. Indian Pediatr. 2024 Sep 15;61(9):887-889. Epub 2024 Jun 20. PMID: 38910368.