Flexible and Rigid Bronchoscopy for Critically Ill Children on Extracorporeal Membrane Oxygenation

被引:1
|
作者
Young, Ashley [1 ]
Patel, Krupa [1 ,2 ,6 ]
Allen, Kiona [1 ,3 ]
Ghadersohi, Saied [1 ,2 ]
Rowland, Matthew [1 ,4 ,5 ]
Hazkani, Inbal [1 ,2 ]
机构
[1] Northwestern Univ, Feinberg Sch Med, Chicago, IL USA
[2] Ann & Robert H Lurie Childrens Hosp Chicago, Div Pediat Otolaryngol Head & Neck Surg, 225 East Chicago Ave, Chicago, IL 60611 USA
[3] Ann & Robert H Lurie Childrens Hosp Chicago, Div Cardiol, Chicago, IL USA
[4] Ann & Robert H Lurie Childrens Hosp Chicago, Dept Anesthesiol, Chicago, IL USA
[5] Ann & Robert H Lurie Childrens Hosp Chicago, Div Crit Care, Chicago, IL USA
[6] Rush Univ, Dept Otorhinolaryngol Head & Neck Surg, Sect Pediat Otolaryngol, Med Ctr, Chicago, IL USA
来源
LARYNGOSCOPE | 2024年 / 134卷 / 09期
关键词
adverse events; bronchial casts; bronchoscopy; extracorporeal membrane oxygenation; flexible; pediatric; pulmonary hemorrhage; rigid; PEDIATRIC BRONCHOSCOPY; COMPLICATIONS; SUPPORT; LUNG;
D O I
10.1002/lary.31460
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Background: We aim to describe our experience with bronchoscopy to diagnose and relieve tracheobronchial obstruction in anticipation of decannulation in children on extracorporeal membrane oxygenation (ECMO) support. Methods: A retrospective cohort study of children on ECMO between 1/2018 and 12/2022. Results: A total of 107 children required ECMO support during the study period for cardiac (n = 48, 45%), pulmonary (n = 38, 36%), or cardiopulmonary dysfunction (n = 21, 20%). Thirty-seven (35%) patients underwent 99 bronchoscopies while on ECMO. Most (76%, n = 75) experienced no improvement or worsening of chest radiography 24 hours following bronchoscopy. Clinical improvement in tidal volumes 48 hours after the first bronchoscopy was noted in 13/25 patients with available data (p = 0.05). Adverse events were seen in 18 (49%) patients who underwent bronchoscopy, including pneumothorax (n = 8, 22%), pneumonia (n = 7, 19%), pulmonary hemorrhage (n = 6, 16%), and sepsis (n = 5, 14%). ECMO courses were longer (25.4 +/- 37.2 vs 6.1 +/- 8.8 days, p < 0.0001) and more likely to be complicated by pneumonia (p = 0.0004) and sepsis (p = 0.047) in patients who underwent bronchoscopy compared with those who did not. Adverse events following bronchoscopy were associated with the number of bronchoscopies (p = 0.0003) and the presence of obstructive materials but not with the type of bronchoscopy or indication for ECMO. Mortality rates were similar between patients who underwent bronchoscopy and those who did not. Conclusion: Children requiring bronchoscopy represent a subset of the sickest children on ECMO. Bronchoscopy may provide benefit in children with persistent cardiopulmonary failure who could not otherwise be decannulated. Adverse events are associated with the number of bronchoscopies and the presence of obstructive material.
引用
收藏
页码:4134 / 4140
页数:7
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