Abstract
Background: Pediatric bronchoscopy is an important tool in pediatric
pulmonology. However, the practices involved in the procedure are
variable. Objective: To evaluate prevalent practice and variations in
pediatric flexible bronchoscopy in India. Methods: An online survey
conducted between September 2018 to March 2019 via Google forms. The
survey was sent to members of the Respiratory Chapter of IAP, personal
contacts, and members of Indian Chest Society. Physicians performing
flexible bronchoscopy in children were asked to respond. Survey had 95
questions in seven domains including patient preparation, sedation,
procedural aspects, monitoring, bronchoscope cleaning, and
complications. Results: The survey received 24 (14 in private sector)
complete responses from 14 cities. Pediatric bronchoscopy was mainly
done for diagnostic purposes. Conscious sedation was used by most (19,
79%). Midazolam plus fentanyl 9 (37.5%) was the preferred sedation
regimen. Routine atropine was used by 4 (16%). For topical anaesthesia-
nebulized only, both nebulized and spray as go, and spray as go
lignocaine only was used by 1 (4.2%), 6 (25%), and 17 (71%) centres,
respectively. The methods of providing oxygen during bronchoscopy were
free flow (9,37.5%), nasal prongs (8,33.3%), mask (6,25%), and LMA
(1,4.2%). Therapeutic procedures included removal of mucus plugs (17,
71%), bronchoscopic intubation (11, 45%) and foreign body removal (10,
41%). The suction for BAL included wall mounted suction in maximum (15,
62.5%). The number of aliquots for BAL varied from 2-6 and volume for
each aliquot also varied (1-2 ml/kg or 5-10 ml). The complications rate
of less than 5 % was reported by almost all. Conclusion: There is large
variation in pediatric flexible bronchoscopy practices across the
country highlighting the need to develop a uniform guideline.