The Indian Journal of Pediatrics

, Volume 82, Issue 10, pp 932–937 | Cite as

The Tools of the Trade — Uses of Flexible Bronchoscopy

  • Varinder SinghEmail author
  • Kamal Kumar Singhal


Bronchoscopes have markedly improved the diagnosis as well as therapy in pediatric pulmonary disorders. Two types of bronchoscopes are available; flexible and rigid, with their own advantages and disadvantages. Depending on the clinical need and availability of skills, choice is made between the two. Typically, rigid scopes are largely used by the surgeons (pediatric or otolayngologists) while flexible bronchoscope stays in the domain of the pediatric pulmonologist and intensivists. Rigid scopes may be more versatile than flexible bronchoscopes in removing the foreign bodies from the airway. Flexible bronchoscopes on the other hand can even be introduced through an endotracheal tube. At times, use of both scopes may be required in a given patient for optimal results. Bronchoscopes give us a means to visualize the inside of the airway, which can be very informative for assessing various pathologies affecting the airways. Apart from the visualization of the parts of the airway tree and their structure as well as patency, it can also be used to take tissue biopsy specimens, collect secretions from the airways and bronchoalveolar lavage which can also get cellular elements from the distal alveoli. In the past few decades, more and more instruments are being used for expanding the utility of flexible bronchoscope for interventions ranging from bronchial toilet, foreign body removal, airway stenting and lasers or cryotherapy for airway lesions. The perinatologists have opened up more vistas and thrown newer challenges for using fiberoptic bronchoscopy (FB) for in utero tracheal occlusion in cases with diaphragmatic hernia. The vast applications of this tool makes it very relevant to pulmonary investigations and therapeutics.


Bronchoscopy Children Intervention Airway anomalies Lavage 



VS and KKS both reviewed the literature and prepared the manuscript. VS will act as guarantor for this paper.

Conflict of Interest


Source of Funding



  1. 1.
    Puhakka H, Kero P, Erkinjuntti M. Pediatric bronchoscopy during a 17-year period. Int J Pediatr Otorhinolaryngol. 1987;13:171–80.CrossRefPubMedGoogle Scholar
  2. 2.
    Wood RE, Fink RJ. Applications of flexible fiberoptic bronchoscopes in infants and children. Chest. 1978;73:737–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Barbato A, Magarotto M, Crivellaro M, et al. Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres. Eur Respir J. 1997;10:1761–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Nicolai T. Pediatric bronchoscopy. Pediatr Pulmonol. 2001;31:150–64.CrossRefPubMedGoogle Scholar
  5. 5.
    Konstan MW, Hilliard KA, Norvell TM, Berger M. Bronchoalveolar lavage findings in cystic fibrosis patients with stable, clinically mild lung disease suggest ongoing infection and inflammation. Am J Respir Crit Care Med. 1994;150:448–54.CrossRefPubMedGoogle Scholar
  6. 6.
    Bush A, de Jongste JC, Carlsen K, Cokugras H. Ultrastructural examination of bronchial specimens from children with moderate asthma. Thorax. 2003;58:187–8.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Midulla F, de Blic J, Barbato A, et al. Flexible endoscopy of paediatric airways. Eur Respir J. 2003;22:698–708.CrossRefPubMedGoogle Scholar
  8. 8.
    Gonzalez C, Eilly JS, Bluestone CD. Synchronous airway lesions in infancy. Ann Otol Rhinol Laryngol. 1987;96:77–80.CrossRefPubMedGoogle Scholar
  9. 9.
    Mancuso RF. Stridor in neonates. Pediatr Clin North Am. 1996;43:1339–56.CrossRefPubMedGoogle Scholar
  10. 10.
    Cerda J, Chacón J, Reichhard C, et al. Flexible fiberoptic bronchoscopy in children with heart diseases: a twelve years experience. Pediatr Pulmonol. 2007;42:319–24.CrossRefPubMedGoogle Scholar
  11. 11.
    Knauer-Fischer S, Ratjen F. Lipid-laden macrophages in bronchoalveolar lavage fluid as a marker for pulmonary aspiration. Pediatr Pulmonol. 1999;27:419–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Bauer ML, Lyrene RK. Chronic aspiration in children: evaluation of the lipid-laden macrophage index. Pediatr Pulmonol. 1999;28:94–100.Google Scholar
  13. 13.
    Ramírez-Figueroa JL, Gochicoa-Rangel LG, Ramírez-San Juan DH, Vargas MH. Foreign body removal by flexible fiberoptic bronchoscopy in infants and children. Pediatr Pulmonol. 2005;40:392–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Tang LF, Xu YC, Wang YS, et al. Airway foreign body removal by flexible bronchoscopy: experience with 1027 children during 2000–2008. World J Pediatr. 2009;5:191–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Dab I, Malfroot A, Goossens A. Therapeutic bronchoscopy in ventilated neonates. Arch Dis Child. 1993;69:533–7.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Schellhase DE. Routine fiberoptic bronchoscopy in intubated neonates? Am J Dis Child. 1990;144:746–7.PubMedGoogle Scholar
  17. 17.
    Bar-Zohar D, Sivan Y. The yield of flexible fiberoptic bronchoscopy in pediatric intensive care patients. Chest. 2004;126:1353–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Languepin J, Scheinmann P, Mahut B, et al. Bronchial casts in children with cardiopathies. Pediatr Pulmonol. 1999;28:329–36.CrossRefPubMedGoogle Scholar
  19. 19.
    Chapotte C, Monrigal JP, Pezard P, et al. Airway compression in children due to congenital heart disease: value of flexible fiberoptic bronchoscopic assessment. J Cardiothorac Vasc Anesth. 1998;12:145–52.Google Scholar
  20. 20.
    Godfrey S, Avital A, Maayan C, Rotschild M, Springer C. Yield from flexible bronchoscopy in children. Pediatr Pulmonol. 1997;23:261–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Kaparianos A, Argyropoulou E, Sampsonas F, et al. Indications, results and complications of flexible fiberoptic bronchoscopy: a 5-year experience in a referral population in Greece. Eur Rev Med Pharmacol Sci. 2008;12:355–63.PubMedGoogle Scholar
  22. 22.
    Maffey AF, Berlinski A, Schkair JC, Teper AM. Flexible bronchoscopy in a pediatric pulmonology service. Arch Argent Pediatr. 2008;106:19–25.PubMedGoogle Scholar
  23. 23.
    Kabra SK, Lodha R, Ramesh P, Sarthi M. Fiberoptic bronchoscopy in children: an audit from a tertiary care center. Indian Pediatr. 2008;45:917–9.PubMedGoogle Scholar
  24. 24.
    Woodhull S, Goh Eng Neo A, Tang Poh Lin J, Chay OM. Pediatric flexible bronchoscopy in Singapore: a 10-year experience. J Bronchology Interv Pulmonol. 2010;17:136–41.Google Scholar
  25. 25.
    Vijayasekaran D, Kalpana S, Ramachandran P, Nedunchelian K. Indications and outcome of flexible bronchoscopy in neonates. Indian J Pediatr. 2012;79:1181–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Kirvassilis F, Gidaris D, Ventouri M, et al. Flexible fiberoptic bronchoscopy in Greek children. Hippokratia. 2011;15:312–5.PubMedCentralPubMedGoogle Scholar
  27. 27.
    Nussbaum E. Pediatric fiberoptic bronchoscopy: clinical experience with 2,836 bronchoscopies. Pediatr Crit Care Med. 2002;3:171–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Field-Ridley A, Sethi V, Murthi S, Nandalike K, Li ST. Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: a systematic review. World J Crit Care Med. 2015;4:77–88.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Cote CJ, Wilson S; for the Work Group on Sedation American Academy of Pediatrics. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118:2587–602.Google Scholar
  30. 30.
    Smyth AR, Bowhay AR, Heaf LJ, Smyth RL. The laryngeal mask airway in fibreoptic bronchoscopy. Arch Dis Child. 1996;75:344–5.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    deBlic J, Marchac V, Scheinmann P. Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures. Eur Respir J. 2002;20:1271–6.CrossRefGoogle Scholar
  32. 32.
    Masters IB, Cooper P. Paediatric flexible bronchoscopy- position paper. J Paediatr Child Health. 2002;38:555–9.CrossRefPubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2015

Authors and Affiliations

  1. 1.Department of PediatricsLady Hardinge Medical College and Associated Kalawati Saran Children’s HospitalNew DelhiIndia

Personalised recommendations