Therapeutic flexible airway endoscopy of small children in a tertiary referral center-11 years' experience

Abstract

Objectives: Use of therapeutic flexible airway endoscopy (TFAE) is very limited in pediatrics. We report our clinical experiences and long term outcomes of TFAE in small children from a single tertiary referral center.

Methods: This is a retrospective cohort study. Small children with their body weight no more than 5.0 kg who had received TFAE between 2005 and 2015 were enrolled. Demographic information and outcomes were reviewed and analyzed from medical charts and TFAE videos.

Results: A total of 313 TFAE were performed in 225 children. The mean age was 3.50 ± 0.24 (0.01-19.2) months old; the mean body weight was 3.52 ± 0.65 (0.57-5.0) kg. A noninvasive ventilation technique, without mask or artificial airway, was applied to support all the procedures. TFAE included laser therapy (39.6%), balloon dilatation plasty (25.6%), tracheal intubation (24.3%) and metallic stent placement (6.4%). Short-length endoscopes of 30-35 cm were used in 96%. All TFAE were successfully completed without serious adverse events or mortality. Mean procedural time was 27.6 ± 16.1 minutes. TFAE resulted in successful extubation immediately in 67.2% (45/67) and 62.8% (118/188) were able to wean off their positive pressure ventilation support in 7 days after procedures. By the end of this study, these TFAE averted the originally suggested airway surgeries in 93.8% (61/65), as benefited from laser therapy, stent implantation, and balloon dilatation plasty.

Conclusions: The TFAE modality of using short-length endoscopes as supported with this noninvasive ventilation and ICU support is a viable, instant and effective management in small children. It has resulted in rapid weaning of respiratory supports and averted more invasive rigid endoscopy or airway surgeries.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Picture of therapeutic flexible airway endoscopy.

A 2.2 kg small premature infant undergoing therapeutic flexible airway endoscopy, a short-length 3.2 mm OD endoscope via left nose, a 6F oxygen catheter via right nose and a 5Fr. balloon catheter via mouth. Endoscopist’s right hand puts around nose and mouth for proceeding nose and mouth-closure.

Fig 2. Sequential images of laser supralaryngoplasty.

Before, during and after the laser ablation of the redundant tissues over bilateral arytenoids with flexible airway endoscopy in severe laryngomalacia. One month later, it became normal.

Fig 3. Sequential images of laser therapy in subglottic stenosis.

Before, during and after the laser ablation with flexible airway endoscopy on a severe subglottic stenosis (

Fig 4. Picture of balloon dilatation plasty.

During the therapeutic flexible airway endoscopy of balloon dilatation plasty in right main bronchus. The synchronized monitor shows spontaneous breathing and stable vital condition.

Fig 5. Picture of carina stent implantation.

During the procedure of left carina stent implantation, a deflating balloon inside the stent lumen after creating a right carina hole. The synchronized monitor shows spontaneous breathing and stable vital signs.