Is there room for another pediatric bronchoscope?

A new technique for transbronchial biopsy in infants and small children

We describe a technique of transbronchial biopsy (TBB) in small children, using a plastic suction catheter as the working channel through which biopsy forceps are introduced. An ultrathin (2.2 mm) flexible fiberoptic bronchoscope (FFB) was used to direct the catheter visually into the desired lung segment and to biopsy selectively. This technique was used nine times to obtain biopsy specimens in six different patients, ranging in age from 3 months to 3 and 4/12 years (mean, 19.2 months). Adequate specimens were obtained in eight of nine procedures (89%). Complications included one pneumothorax that did not require evacuation and one episode of sedation-induced hypoventilation that required brief bag-mask ventilation. No significant bleeding occurred. This technique enabled us to obtain lung tissue in infants and small children without resorting to general anesthesia and rigid bronchoscopy.

Assessment of lung function in the intensive care unit

Tests of pulmonary function have become more accurate and less invasive in recent years. Our ability to monitor patients continuously with pulse oximetry, transcutaneous and end-tidal CO2, and intraarterial blood gas monitors has greatly enhanced ICU care. In intubated patients in the PICU detailed lung function studies can be performed, and in general they can be carried out with minimal disruption of routine management. Much work remains to be done to define the changes seen in various disease processes and the effects of therapeutic interventions on functional parameters. Many of the available techniques have already been developed to a point that allows them to be employed in clinical decision making. We expect that assessment of lung volumes, compliance, and resistance will become a routine part of management in children with life-threatening pulmonary diseases in the near future, and that a more intimate knowledge of the pathophysiology of respiratory disorders treated in PICU will lead to improved outcomes.