Application Of Electronic Bronchoscopy In Patients With Difficult Weaning In Picu

Objective: To investigate the diagnostic and treatment value of electronic bronchoscopy of patients who are difficult weaning from ventilator in pediatric intensive care units(PICU).Methods: A retrospective review of 92 patients receiving electronic bronchoscopy procedures from March 2013 to December 2015 in Children’s Hospital of Chongqing Medical University. We divided these 92 patients into two groups( < 3 years group and≥3 years group), and compared the underlying diseases and the findings of electronic bronchoscopy. To evaluate the airway of children with congenital heart disease(CHD), and we studied the association between airway narrowing or malacia and difficult weaning in this population. Cases who were confirmed to have atelectasis or consolidation were treated with bronchoalveolar lavage and(or) one-lung ventilation. Our descriptive statistics were generated with continuous data and reported as the median, categorical data were reported as number and percentages. For comparison, patients were divided into two groups according to their ages: younger than 3 years old(<3 years) and equal to or older than 3 years old(≥3 years). Differences between the two groups were determined with the chi-square test or fisher’s exact test for categorical data. The grade data were analysed using the rank sum test. The P-value <0.05 was considered to be statistically significant.Results: In our study, small infants with an age of <3 years accounted for the largest population that received electronic bronchoscopy(n=55, 59.8%), a total of 182 procedures were performed on 92 patients. Most of the patients(n=58, 63.0%) only needed one procedure, only 4 patients(4.3%) received electronic bronchoscopy more than 5 times. Analyzing the underlying diseases of the patients reveals that respiratory disease was the most common, followed by cardiovascular disease. The positive finding rate of electronic bronchoscopy was 94.6%(n=87), with excessive airway secretions or(n=42, 45.7%)being the most common, tracheobronchial narrowing or malacia(n=24, 26.1%), Laryngomalacia(n=9, 9.8%), glottis and subglottis narrowing(n=10, 10.9%), laryngeal oedema(n=15, 16.3%), plastic bronchitis(n=7,7.6%), mucus plugging(n=3, 3.3%), foreign body(n=2, 2.2%), Bronchial atresia(n=3, 3.3%). In the upper airway obstruction, the laryngeal oedema was the most common finding(n=15,44.1%), In the lower airway obstruction, the tracheobronchial narrowing or malacia was the most common finding(n=13,54.2%). There are 19 cases of tracheobronchial narrowing or malacia in 28 children with congenital heart disease, and the left bronchial narrowing is the most common finding(n=14,73.7%). A comparison between the two groups(difficult weaning group and non-difficult weaning group) shows that tracheobronchial narrowing or malacia was no significantly. Tracheobronchial narrowing or malacia calibre on bronchoscopy had a sensitivity of 68.4% and specificity of 66.7%. In 36 patients with atelectasis or consolidation, full re-expansion was obtained in 3(8.0%) patients, partial re-expansion in 20(52.6%) and no change in 15(39.4%) within 24 hours after the electronic bronchoscopy procedure. Transient hypoxemia occurred transiently during 6(3.3%) procedures, especially in small and high-risk patients, they were all quickly resolved using appropriate management. No significant airway trauma, serious hypotension, hemorrhage, respiratory or cardiac arrest, anesthesia accident or death occurred during any of these procedures.Conclusions: In our study, small infants with an age of <3 years accounted for the largest population that received electronic bronchoscopy, underlying diseases of the patients reveals that respiratory disease was the most common. The neurological disease was frequently noted in the ≥3 years group. The common findings in children who were difficult weaning from ventilator were airway malformation and excessive airway secretions. Tracheobronchial narrowing or malacia on electronic bronchoscopy is noted frequently in patients with congenital heart disease. Overall assessment and presence of narrowing or malacia on bronchoscopy had poor sensitivity and specificity for difficult weaning in this population. And the bronchoalveolar lavage and one-lung ventilation had an important role in helping re-expansion.