Fiberoptic bronchoscopy in the treatment of intubated neonates
E. S. Shinwell, R. D. Higgins, R. L. Auten and D. L. Shapiro
Department of Pediatrics (Neonatology), University of Rochester, School of Medicine, NY.
A study of the role of fiberoptic bronchoscopy in intubated neonates was
conducted. The study aimed to ascertain the applicability of fiberoptic
bronchoscopy for assessment of endotracheal tube tip position, and to
assess the incidence and clinical significance of airway disease in
unselected patients. Seventy examinations on 65 neonates were performed
without interruption of mechanical ventilation. The procedure was well
tolerated in all cases. The accuracy of bronchoscopic measurement of
endotracheal tube tip position improved markedly with user experience and
reached a correlation of .96 with a chest roentgenogram. Although the
technique was safe and accurate, the need for available and skilled
personnel may limit the applicability of this method for endotracheal tube
tip position assessment. Significant airway disease requiring a change in
treatment was found in 13 patients (19%). This high incidence of
significant but clinically unsuspected airway disease suggests that there
should be more frequent consideration of diagnostic bronchoscopy in all
sick intubated neonates who are at risk for airway disease.