2006, Number 1
Acta Pediatr Mex 2006; 27 (1)
Bronchoscopy in children with persistent atelectasis. Endoscopic findings and results of selective aspiration (1994-2003)
Cuevas-Schacht F, Garrido-Galindo C, Sosa-de-Martínez MC, Pérez-Fernández LF
PDF size: 71.47 Kb.
To determine antecedents and clinical characteristics of persistent atelectasis in patients who underwent a bronchoscopic study, in terms of their radiological evolution 24 h later.
Retrospective, longitudinal, descriptive and observational.
Place and date:
Endoscopy Service of the National Institute of Pediatrics, between January 1st, 1994 and August 31st, 2003.
Material and methods:
All clinical-radiological files of patients with persistent atelectasis who underwent a bronchoscopical examination were studied. The following information was retrieved: age, gender, the following antecedents: prematurity, pneumopathy due to aspiration, previous surgery, respiratory infection, mechanical ventilation, evolution (in days), and previous treatment; regarding the atelectasis: endoscopic location, procedure, clinical and radiological evolution 24 h after the procedure. Information was described graphically and numerically. As explanatory variable, radiological evolution 24 h after the bronchoscopy was used. When the response variable was categorical, Chi-square test was performed; when continuos, the Kruskal-Wallis test. All tests were two-tailed with α=0.05.
One hundred and seventeen patients fulfilled the selection criteria. In 29 patients no radiological improvement was observed; in 56, partial improvement; in 32, the problem was solved. No significant differences were detected in terms of gender, nor the rest of the antecedents. In the three groups, during the endoscopic procedure the most frequent findings were: some degree of mucous endobronchitis; in the lumen, mucous hypersecretion; in the wall, dyscinesia. When the radiological and the clinical evolution were correlated by means of a weighted kappa test, a fairly good association (κ=0.73) was observed, which was highly significant (p‹=.0001).
When we compared the present study with the one we performed between 1990-1992, highly significant differences (p ‹0.01) were detected, since in this study we obtained 27% of cures versus 7% in the previous study, possibly due to the experience acquired in the management of these patients, as well as the improved techniques performed in this study.
Hernández CO, Suárez-López-de-Vergara RG, Rodríguez-Fernández O. Atelectasias. En: Cobos-Barroso N, Perez-Yarza E [eds]. Tratado de Neumología Infantil. Madrid. Ed. Ergon 2003;pp863-76.
Shinwell ES. Ultrathin fiberoptic bronchoscopy for airway toilet in neonatal pulmonary atelectasis. Ped Pulmonol 1992;13:48-9.
Delgadillo-Avendaño JM, Cuevas Schacht FJ, Pérez-Fernández LF. Broncoscopia rígida en recién nacidos. Acta Pediatr Mex 1993;14(4):158-62.
Nussbaum E. Pediatric flexible bronchoscopy and its application in infantile atelectasis. Clin Pediatr 1985;24:379-82.
Muntz HR. Therapeutic rigid bronchoscopy in the neonatal intensive care unit. Ann Otol Rhinol Laryngol 1985;94:462-5.
Fan LL, Sparks LM, Fix EJ. Flexible fiberoptic endoscopy for airway problems in a pediatric intensive care unit. Chest 1988;93(3):556-60.
Wiseman NE, Sanchez I, Powell RE. Rigid bronchoscopy in the pediatric age group: diagnostic effectiveness. J Pediatr Surg 1992;27(10):1294-7.
Haenel JB, Moore FA, Moore EE, Read RA. Efficacy of selective intrabronchial air insufflation in acute lobar collapse. Am J Surg 1992;164:501-5.
Cuevas Schacht F, Ortega Iglesias JC, Sosa de Martínez C, Garrido Galindo C, Pérez-Fernández LF. Broncoscopia en pacientes pediátricos con atelectasia persistente. Hallazgos endoscópicos y resultados de la aspiración selectiva entre 1990 y 1992. Acta Pediatr Mex 2005;26(2):62-6.
Sosa-de-Martínez MC, Pablos-Hach JL, Santos-Atherton D. Guía para elaborar el protocolo de investigación. Parte 2. Clasificación del protocolo de investigación. Acta Pediatr Mex 1994;15:139-45.
Dixon WJ, Brown MB. Biomedical Computer Programs, D-Series (BMDP) Berkeley, Calif. Univ. of California Press 1992.
Zar JH. Biostatistic Analysis. Englewood Cliffs, NJ. Prentice-Hall Inc. 1974;pp230-3.
Leach C. Introduction to statistics. A nonparametric approach for the social sciences. New York. John Wiley & Sons 1979.
Feinstein AR. Clinical Biostatistics LIV. The biostatistics of concordance. Clin Pharmacol Ther 1981;29:111-23.
Karlson KH Jr. Atelectasis. En: Hilman BC. Pediatric Respiratory Disease, Diagnosis and Treatment. W.B Saunders Co. Philadelphia 1994;pp436-9.
Hazinski TA. Atelectasis. En: Kendig’s Disorders of the Respiratory Tract in Children. Philadelphia. W. B Saunders Co. 1998;pp634-41.
Friedman EM, Williams M, Healy GB. McGill TGI. Pediatric endoscopy: a review of 616 cases. Ann Otol Rhinol Laryngol 1984;93:517-9.
Al-Alaiyan S, Dyer D, Khan B. Chest physiotherapy and post-extubation atelectasis in infants. Pediatr Pulmonol 1996;21:227-30.
Kreider M, Lipson D. Bronchoscopy for atelectasis in the ICU. A case report and review of the literature. Chest 2003;124:344-50.
Millen JE, Vandree J, Glauser FL. Fiberoptic bronchoscopic balloon occlusion and reexpansion of refractory unilateral atelectasis. Crit Care Med 1978;6:50-5.
Wood RE. The emerging role of flexible bronchoscopy in pediatrics. Clin Chest Med 2001;22:311-17.
Chhajed PN, Cooper P. Pediatric flexible bronchoscopy [Technology update]. Indian Pediatr 2001;38:1382-92.