Bronchoscopic Findings In Children With Prolonged Mechanical Ventilation
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Date
2013
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Abstract
Introduction: Prolonged mechanical ventilation through tracheostomy may produce anatomical and functional alterations in the airway.On one hand, mantained positive pressure in the airway may produce dilatation and deformity of the structures, and on the other hand,tracheostomy inadequate care may produce erosion and anomalous cicatrization. Thus, malacia, stenosis, and granuloma have beendescribed as the most frequent alterations in these patients. Objective: Describe bronchoscopic findings in children with prolongedmehanical ventilation, and changes in time. Patients and methods: Retrospective review of reports of all flexible bronchoscopies done inpatients with prolonged mechanical ventilation (defined as more than 30 days of mechanical ventilation) hospitalized in our institution.Results: 91 bronchoscopies realized in 57 patients were analyzed. Of the total, 31 are male, and the median age at procedure was 20.7months (range 4.2-128). All patients have tracheostomy and 53 mechanical ventilation at the time of the procedure. The most frequentendoscopic findings were: 23 malacia of lower airway (tracheomalacia or bronchomalacia), 22 granulomas, and 20 subglottic stenosis invariable degree. Endoscopic control was made in 25 patients, evidencing a reduction of stenosis degree in 4 of them, in 3 a reduction ofmalacia degree, and in 7 appearance of granulomas. Conclusions: The routine bronchoscopic evaluation is essential in the follow up ofpatients with prolonged mechanical ventilation. Injuries in respiratory tract are frequent and must be under surveillance in order to avoidfurther complications.