Abulebda K, Abu-Sultaneh S, Ahmed SS, Moser EAS, McKinney RC, Lutfi R. Intensivist-based deep sedation using propofol for pediatric outpatient flexible bronchoscopy. World J Crit Care Med 2017; 6(4): 179-184 [PMID: 29152464 DOI: 10.5492/wjccm.v6.i4.179]
Corresponding Author of This Article
Dr. Kamal Abulebda, Department of Pediatrics, Section of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Dr, Phase 2, Room 4900, Indianapolis, IN 46202, United States. kabulebd@iupui.edu
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Nov 4, 2017; 6(4): 179-184 Published online Nov 4, 2017. doi: 10.5492/wjccm.v6.i4.179
Intensivist-based deep sedation using propofol for pediatric outpatient flexible bronchoscopy
Kamal Abulebda, Samer Abu-Sultaneh, Sheikh Sohail Ahmed, Elizabeth A S Moser, Renee C McKinney, Riad Lutfi
Kamal Abulebda, Samer Abu-Sultaneh, Sheikh Sohail Ahmed, Renee C McKinney, Riad Lutfi, Department of Pediatrics, Section of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, United States
Elizabeth A S Moser, Department of Biostatistics, Indiana University School of Medicine and Richard M Fairbanks School of Public Health, Indianapolis, IN 46202, United States
Author contributions: Abulebda K and Lutfi R contributed equally to this work; Abulebda K, Abu-Sultaneh S, Ahmed SS and Lutfi R designed the research; McKinney RC collected the data; Moser EAS contributed to the statistical analysis; Abulebda K drafted the first draft of the paper; the entire author group critically reviewed and approved the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Indiana University.
Informed consent statement: Patients were not required to give informed consent as the study was retrospective and all clinical patient data was de-identified before data analysis.
Conflict-of-interest statement: The authors have no conflict of interest or financial relationships to disclose.
Data sharing statement: Data was not shared amongst institutions.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Kamal Abulebda, Department of Pediatrics, Section of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Dr, Phase 2, Room 4900, Indianapolis, IN 46202, United States. kabulebd@iupui.edu
Telephone: +1-317-9449674 Fax: +1-317-9443442
Received: February 6, 2017 Peer-review started: February 12, 2017 First decision: May 17, 2017 Revised: June 30, 2017 Accepted: September 3, 2017 Article in press: September 4, 2017 Published online: November 4, 2017 Processing time: 268 Days and 23.8 Hours
Abstract
AIM
To evaluate the safety and efficacy of sedating pediatric patients for outpatient flexible bronchoscopy.
METHODS
A retrospective chart review was conducted for all children, age 17 years or under who underwent flexible bronchoscopy under deep sedation in an outpatient hospital-based setting. Two sedation regimens were used; propofol only or ketamine prior to propofol. Patients were divided into three age groups; infants (less than 12 mo), toddlers (1-3 years) and children (4-17 years). Demographics, indication for bronchoscopy, sedative dosing, sedation and recovery time and adverse events were reviewed.
RESULTS
Of the total 458 bronchoscopies performed, propofol only regimen was used in 337 (74%) while propofol and ketamine was used in 121 (26%). About 99% of the procedures were successfully completed. Children in the propofol + ketamine group tend to be younger and have lower weight compared to the propofol only group. Adverse events including transient hypoxemia and hypotension occurred in 8% and 24% respectively. Median procedure time was 10 min while the median discharge time was 35 min. There were no differences in the indication of the procedure, propofol dose, procedure or recovery time in either sedative regimen. When compared to other age groups, infants had a higher incidence of hypoxemia.
CONCLUSION
Children can be effectively sedated for outpatient flexible bronchoscopy with high rate of success. This procedure should be performed under vigilance of highly trained providers.
Core tip: In this retrospective study “Intensivist-based deep sedation using propofol for pediatric outpatient flexible bronchoscopy”, we are presenting our center data on pediatric patients who underwent flexible bronchoscopy under deep sedation using propofol. The study outlines our experience with intensivist-based procedural sedation as an effective strategy to facilitate successful completion of flexible bronchoscopy. This is the largest retrospective study describing the use of propofol-based procedural sedation in the outpatient settings for pediatric flexible bronchoscopy.
