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Flexible fibreoptic bronchoscopy is beneficial in children on extracorporeal membrane oxygenation support.

Authors :
Babhalgaonkar P
Forster G
Masters IB
Haisz E
Mattke A
Rahiman S
Source :
Australian critical care : official journal of the Confederation of Australian Critical Care Nurses [Aust Crit Care] 2025 Jan; Vol. 38 (1), pp. 101071. Date of Electronic Publication: 2024 Jul 03.
Publication Year :
2025

Abstract

Background: Flexible fibreoptic bronchoscopy (FFB) has the potential to enhance diagnostic capabilities and improve pulmonary function in children on extracorporeal membrane oxygenation (ECMO).<br />Objectives: The objective of this study was to evaluate the benefits (clinical, radiological, and microbiological) of FFB and assess associated complications in children on ECMO.<br />Methods: We conducted a single-centre retrospective observational cohort study in a tertiary paediatric intensive care unit. All FFB episodes performed during the study period on children aged 0-18 years on ECMO were included.<br />Results: Out of the 155 children who received ECMO, 36 (23%) underwent a total of 92 episodes of FFB. FFB provided anatomical and pathological information in 53% (19/36) of cases and proved beneficial in clearing the airways in 62% (54/87) of the episodes. Overall, patients exhibited transient increases in ECMO and mechanical ventilation support 1 h post FFB in 14% (13/92) and 9.7% (9/92) episodes, respectively. At 6 h, the mean fraction of inspired oxygen on the mechanical ventilator was lower (0.46 [±0.21] vs 0.53 [±0.21] p < 0.01), with no change in mean airway pressure. Similarly, compared to pre-FFB, the fraction of inspired oxygen on the mechanical ventilator on ECMO was lower at 6 h and 24 h (0.65 [±0.25] vs 0.71 [±0.23] p < 0.01 and 0.006, respectively), with no significant change in the sweep gas flow and ECMO flow. The radiological imaging indicated improved or stable findings in 91% (83/91) of FFB episodes. FFB contributed to the identification of new and previously unknown microbiological information in 75% (27/36) of the patients. The incidence of major complications was 7.6%. Minor self-resolving bleeding occurred in 25% (23/92) episodes, and major bleeding occurred in two episodes, with a total of 10 episodes needing blood product transfusion.<br />Conclusions: FFB is a valuable adjunct in managing children with severe respiratory failure on ECMO, offering clinical benefits with a low rate of major complications. Further studies should aim to develop a consensus approach encompassing criteria and clinical management around FFB in patients on ECMO.<br /> (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1036-7314
Volume :
38
Issue :
1
Database :
MEDLINE
Journal :
Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
Publication Type :
Academic Journal
Accession number :
38960744
Full Text :
https://doi.org/10.1016/j.aucc.2024.05.008