Pediatric Bronchoscopy for Clinicians

This book is a quick reference guide and atlas for performing bronchoscopy in pediatric patients. It offers a multidisciplinary approach, incorporating the perspectives of pediatric pulmonology, otolaryngology, anesthesiology, and respiratory therapy by outlining important anatomic and physiologic considerations. It describes the basic and advanced techniques in performing flexible, rigid, and special bronchoscopy maneuvers and approaches. This book enhances the reader’s understanding of the critical skill of clinical evaluation and management of the pediatric airway. It is addressed to junior and senior trainees as well as early- and late-career clinicians involved in pediatric bronchoscopy as an on-the-go guide. Key Features • Pays special attention to including widely applicable techniques that can be employed across a variety of domestic and international practical settings, complete with a wealth of accompanying videos and illustrations from real-world experiences that are easy to replicate and reference in practice. ● Promotes a multidisciplinary approach to the evaluation of the upper and lower airways in children with respiratory and aerodigestive pathology as the lines between pediatric pulmonology, otolaryngology, anesthesiology, surgery, critical care, and emergency medicine are blurring, thus providing wellequipped clinicians with a thorough perspective of all disciplines. ● Features bullet-pointed lists for pre-procedure evaluation, with procedural checklists, images, and videos, and serves as a portable, compact, and accessible quick reference guide. Cover Half Title Title Page Copyright Page Dedication Table of Contents Preface Acknowledgments Editors Contributors Chapter 1 Clinical indications for bronchoscopy Introduction Advantages of bronchoscopy over clinical assessment and chest radiography Clinical Applications of Rigid Bronchoscopy Evaluate airway anatomy Assess airway dynamics Obtain clinical samples Therapeutic intervention Clinical Applications of Flexible Bronchoscopy Evaluate airway anatomy Assess airway dynamics Obtain clinical samples Therapeutic intervention Case Presentation Conclusion Tips for Clinical Practice References Chapter 2 Basics of flexible bronchoscopy and equipment Introduction What is flexible bronchoscopy? About the instruments: flexible versus rigid bronchoscopes Flexible bronchoscopes Advantages of flexible bronchoscopy over rigid bronchoscopy Advantages of performing a combined airway evaluation Equipment The minimum equipment we recommend for a bronchoscopy program Bronchoscopy supply items Components of the flexible bronchoscope (Figures 2.4, 2.5, and 2.6) Basics of handling a flexible bronchoscope Preparation for a flexible bronchoscopy What do you need to know before performing a flexible bronchoscopy? Performing Flexible Bronchoscopy: Steps and Technique “Driving” (manipulation) of the flexible bronchoscope: Tips17 Obtaining a bronchoalveolar lavage (BAL)3,18–20 Post-bronchoscopy care of the patient17,22–24 Procedure report Bronchoalveolar lavage specimen processing19 Nosocomial infections and flexible bronchoscopy Transportation of the flexible bronchoscope Care of the flexible bronchoscope Leak test Cleaning and sterilization3,7,25,26 Storage of the bronchoscope Team Approach and Building a Bronchoscopy Service17,23 Conclusion References Chapter 3 Basics of microlaryngoscopy and rigid bronchoscopy Introduction Rigid bronchoscopes Advantages of rigid bronchoscopy Preparation Anesthesia Room Arrangement Patient factors Equipment Technique Use of the rigid ventilating bronchoscope Conclusion Tips for Clinical Practice References Chapter 4 Upper airway bronchoscopic interpretation Introduction Nasal cavity Nasopharynx Soft palate Oral Cavity and Oropharynx Hypopharynx Epiglottis and supraglottic larynx Larynx Subglottis Proximal Trachea Conclusion Tips for clinical practice References Chapter 5 Lower airway bronchoscopic interpretation Introduction Advantages of flexible bronchoscopy over rigid bronchoscopy for evaluation of the lower airways Pearls Normal Lower Airway Anatomy Trachea Bronchi Pearls Common Lower Airway Abnormalities Subglottis Trachea Pearls Bronchial tree Pearls Conclusion References Chapter 6 Upper airway bronchoscopic approach and diagnostic procedures Introduction Drug-induced sleep endoscopy (DISE) Bronchoscope-assisted transnasal intubation Intubation via a supraglottic airway device Conclusion Tips for Clinical Practice References Chapter 7 Lower airway bronchoscopic approach and diagnostic procedures Introduction Indications for lower airway evaluation Potential complications Equipment General preparation Positioning Lower Airway Interventions Bronchoalveolar lavage (BAL) Bronchial washing Bronchoscopic Biopsies Cytologic bronchial brushing Endobronchial biopsy Transbronchial biopsy Foreign Body Removal Conclusion Tips for Clinical Practice References Chapter 8 Advanced bronchoscopic procedures Introduction Endobronchial Ultrasound with or without Transbronchial Needle Biopsy Preparation, positioning, and anesthesia Equipment Technique Endobronchial biopsy Preparation, positioning, and anesthesia Equipment Technique Airway Stenting Preparation, positioning, and anesthesia Equipment Technique Maintenance Endobronchial Valves Equipment Technique Endobronchial blocker Equipment Technique Cryotherapy Equipment Technique Laser Preparation, positioning, and anesthesia Equipment Technique Conclusion Tips for Clinical Practice References Chapter 9 Bronchoscopy for specific situations Introduction Foreign body removal History Large-volume/massive pulmonary hemorrhage Initial Management The Aerodigestive Patient and Combined Endoscopy Traumatic Aerodigestive Injuries Tracheopathies Mucopolysaccharidoses (MPS) Select Tracheal Cartilage Abnormalities Whole-lung lavage Plastic bronchitis Conclusion and Tips for Clinical Practice References Chapter 10 Bronchoscopy training and simulation for medical education Introduction Teaching methods Cognitive phase of pediatric bronchoscopy training Medical knowledge – Anatomy and physiology of the pediatric airway Technical, instrumental, and clinical knowledge Modes of delivering theoretical knowledge Practical Training for Pediatric Bronchoscopy – Current State of Simulation Bronchoscopy simulators Practicing non-technical skills Practical Training for Pediatric Bronchoscopy – Intra-Operative Teaching Accreditation: Training requirements and competency assessment tools Continuous professional development Future opportunities Conclusion Tips for Clinical Education References Chapter 11 Airway management and anesthetic considerations Introduction Location – bedside/intensive care unit versus operating room/endoscopy suite Airway Securement Medications for pediatric bronchoscopy Complications during Pediatric Bronchoscopy Conclusion Tips for Clinical Practice References Index Key Features• Special attention is given to include widely applicable techniques that can be employed across a variety of domestic and international practice settings, complete with a wealth of accompanying videos and illustrations from real-world experiences that are easy to replicate and reference in practice.• Promotes a multidisciplinary approach to evaluation of the upper and lower airways in children with respiratory and aerodigestive pathology as the lines between pediatric pulmonology, otolaryngology, anesthesiology, surgery, critical care, and emergency medicine are blurring, thus providing well-equipped clinicians a thorough perspective of all disciplines.• Features bullet-pointed lists for pre-procedure evaluation with procedural checklists and photographs, and serves as a portable, compact and more amenable quick reference guide