Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: A systematic review

Table 2 Adverse events reported with flexible bronchoscopy in critically ill pediatric patients

Ref.	Hypoxia	Bradycardia/Hypoxia	Hypotension	Hemorrhage	Other
Bar-Zohar et al[24], 2004	0% (0/155)	0% (0/155)	19.3% (30/155) 12.9% (20/155) NS bolus	0% (0/155)	1.3% (2/155) intubated for mucus plug
Davidson et al[17], 2008				0% (0/200)	0.5% (1/200) patient “instability”
de Blic et al[4], 1991	70.3% (26/37) transient moderate hypoxia (SaO2 > 80)	0% (0/37)
Efrati et al[16], 2009	6.6% (21/319), resolved - O2 0.3% (1/319) - BMV 0.3% (1/319) required intubation	3.4% (11/319), resolved - O2 and atropine		1.6% (5/319), resolved-saline lavage	1.6% (5/319) stridor resolved -steroids or epinephrine 0.9% (3/319) fever
Fan et al[26], 1988	2.3% (2/87), resolved - removal of scope or O2	0% (0/87)
Hintz et al[22], 2002				37.5% (3/8)
Kamat et al[19], 2011				34.2% (53/155) mild to moderate blood tinged secretions 2% (3/155) placed on HFOV for increased bloody secretions
Kohelet et al[27], 2011		Transient (number not reported)	0% (0/25)	0% (0/25)	4% (1/25) pneumothorax
Kotby et al[29], 2008	42.9% (15/35), transient		5.7% (2/35), transient	22.9% (8/35)	Decreased PaO2
Manna et al[20], 2006	10.8% (16/148) transient; 16.7% (3/18) of ARDS patients		17.6% (26/148), NS bolus		0.6% (1/148) rigid chest after fentanyl
Nussbaum et al[31], 2002	0.7% (21/2836), of those 76.2% (16/21) resolved - removal of scope or O2; 23.8% (5/21) emergency intubation; 2/5 apneic prior to FFB	Transient (number not reported)	0% (0/2836)	4% (113/2836) mild nasopharyngeal bleeding 0.4% (12/2836) bleeding after biopsy, resolved - epinephrine lavage	Transient stridor (number not reported) 0.6% (17/2836) laryngo/bronchospasm, resolved - albuterol and O2, BMV 9.5% (2/21) rigid chest after fentanyl
Peng et al[32], 2011	Transient (number not reported)	Transient (number not reported)			0.8% (6/725) laryngospasm, resolved - lidocaine spray and NIPPV 0.3% (2/725) pneumothorax 29.5% (214/725) fever
Pietsch et al[37], 1985					13.3% (2/15) death secondary to mainstem bronchus perforation 6.7% (1/15) pneumothorax - chest tube
Prentice et al[23], 2011				5.9% (1/17), resolved - epinephrine lavage
Soong et al[33], 1995		4% (10/247) transient, resolved - removal of scope or O2 1.2% (3/247) required BMV		Self-limited nasal bleeding (number not reported)	2% (5/247) stridor
Tang et al[3], 2009	20.8% (11/53), mild			3.8% (2/53), mild	1.9% (1/53) SVT 1.9% (1/53) pneumothorax 1.9% (1/53) bronchospasm

ARDS: Acute respiratory distress syndrome; BMV: Bag mask ventilation; FFB: Flexible fiberoptic bronchoscopy; HFOV: High frequency oscillatory ventilation; NIPPV: Noninvasive positive pressure ventilation; NS: Normal saline; O₂: Oxygen; PaO₂: Arterial partial pressure of oxygen; SVT: Supraventricular tachycardia.