Therapeutic Bronchoscopic Interventions for Non Foreign‐Body Removal Indications in Children

• Published in: Pediatric pulmonology 2025-01, Vol.60 (1), p.e27462-n/a
• Main Authors: Madan, Karan, Agarwal, Sheetal, Shrikanta, Jingade T., Mehta, Ravindra, Devi, Kaumudi, Pattabhiraman, Vallandramam R., Srinivasan, Arjun, Mittal, Saurabh, Hadda, Vijay, Tiwari, Pawan, Jat, Kana R., Dhochak, Nitin, Mohan, Anant, Guleria, Randeep, Kabra, Sushil K.
• Format: Article
• Language: English
• Subjects: Adolescent; Airway management; Airway Obstruction - etiology; Airway Obstruction - surgery; bronchoscopy; Bronchoscopy - methods; central airway obstruction; Child; Child, Preschool; Female; Humans; Infant; Male; Retrospective Studies; Tracheal Stenosis - surgery; tuberculosis; tumor
• ISSN: 8755-6863; 1099-0496; 1099-0496
• DOI: 10.1002/ppul.27462

ABSTRACT Background The indications for pediatric airway endoscopy are expanding and a variety of therapeutic interventions are feasible for central airway obstruction (CAO) and other central airway pathologies, apart from foreign body removal. Methods In this retrospective chart review from four centers, we describe the indications, procedures, outcomes, and complications of therapeutic bronchoscopic interventions in children for non foreign‐body removal indications. Results A total of 72 children (mean age:140 [60.4] months) underwent 143 therapeutic bronchoscopic airway interventions under general anesthesia, via a rigid or flexible bronchoscope or both, between January 2015 and November 2023. 67 (93%) had CAO. The most common diagnoses were posttubercular tracheobronchial stenosis (29%) followed by central airway tumor (26%) and postintubation/posttracheostomy tracheal stenosis (26%). Airway stenosis (subglottic/tracheal/bronchial) was the commonest bronchoscopic finding (43 [59.7%]) followed by endoluminal growth/mass (21 [29.2%]). The most frequently performed procedure was airway dilatation (38, 52.7%), using balloon dilators (89.5%) or rigid bronchoscope (10.5%). Endoluminal tumor debulking was performed in 21 (29%). Assistive modalities included electrocautery (44%), mechanical debulking (10%), cryotherapy (10%), or laser (4%). Airway stent insertion alone or in combination with airway dilatation or debulking was performed in 24 (33.3%) children. The airway conduit used was supraglottic airway in 19 (26%) and rigid bronchoscope in 53 (74%) children. Immediate procedural success was observed in 66 (92%) patients. Fourteen (19.4%) patients had minor procedural complications. Thirty‐three (46%) children required a repeat bronchoscopic procedure. Conclusion Like adults, multimodality therapeutic bronchoscopic airway interventions are feasible and safe in children for CAO and other central airway indications.