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Birnkrant David J. M.D.; Besunder, James B. D.O.
Journal of Bronchology: July 1995
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Pediatric flexible bronchoscopy (FFB) and bronchoalveolar lavage (BAL) have been proven safe and effective in many clinical settings. However, insufficient attention has been paid to the description of a safe bronchoscopic technique in critically ill infants and children. Previously described techniques of FFB and BAL have been associated with bradycardia and/or oxyhemoglobin desaturation in mechanically ventilated pediatric patients. We retrospectively evaluated the safety of using manual ambu-bag ventilation with 100% oxygen to perform 13 FFB and BAL procedures in 11 critically ill pediatric patients. The setting was an urban pediatric intensive care unit. There were no major complications, such as bleeding, abscess, or pneumothorax, and no episodes of acute acidosis, oxyhemoglobin desaturation, or bradycardia associated with the procedures. Systolic blood pressure was elevated by 10 mm Hg after 5 of 13 procedures. Compared to previously described techniques, manual ambu-bag ventilation with 100% oxygen provides superior cardiopulmonary stability during FFB and BAL in mechanically ventilated pediatric patients. Although the significance of systolic blood pressure elevation after FFB and BAL is unknown, our study supports the conclusion that FFB and BAL can be performed safely in critically ill infants and children.

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