What is the complication rate of bronchoscopy in pediatric oncology patients?

From the Guidelines

The complication rate of bronchoscopy in pediatric oncology patients is approximately 5% or less, with most complications being minor and transient, such as epistaxis, airway bleeding, excessive cough, and transient laryngospasm. According to the study published in the European Respiratory Journal 1, the most frequent causes of oxygen desaturation in children undergoing bronchoscopy are partial or total airway obstruction by the bronchoscope and depression of respiratory drive by sedation. The study also highlights that oxygen desaturation is more frequent in younger infants, and that oxygen supplementation may delay detection of reduced ventilation, but can help decrease the incidence and severity of hypoxia if administered during procedures undertaken using sedation 1.

Key Complications and Considerations

• Minor complications: epistaxis, airway bleeding, excessive cough, and transient laryngospasm
• Major complications: apnoea, bradycardia, and important oxygen desaturation (Sa,O2 < 90%) either isolated or secondary to laryngospasm or bronchospasm
• Post-procedure atelectasis is another possible complication
• Pediatric oncology patients may have a slightly higher risk of complications due to potential immunosuppression, thrombocytopenia, and underlying lung pathology from their cancer or treatments

Pre-Procedure Optimization and Procedure Considerations

• Ensure adequate platelet counts and correct coagulopathies before the procedure
• Assess respiratory status before the procedure
• The procedure should be performed by experienced pediatric bronchoscopists in centers equipped to manage potential complications
• Close observation of the child and capnography where appropriate are crucial to detect reduced ventilation and oxygen desaturation 1

From the Research

Complication Rate of Bronchoscopy in Pediatric Oncology Patients

• The complication rate of bronchoscopy in pediatric patients is relatively low, with a study finding that intraprocedural complications occurred in 7.2% of all procedures, and postprocedural adverse events were documented in 25.8% of cases 2.
• The most common intraprocedural complication was hypoxemia, occurring in 4.8% of cases, while the most common postprocedural adverse events were fever and transient oxygen dependency, occurring in 14.2% and 13.4% of cases, respectively 2.
• Risk factors for complications included age below two years and primary ciliary dyskinesia, with age below two years and underlying cardiovascular disease being independent risk factors for severe complications 2.
• Another study found that the complication rate for diagnostic bronchoscopies was 0.88%, with major complications requiring premature termination and pneumothoraces being the most common complications 3.
• A retrospective study of pediatric bronchoscopies found that the main complication during the procedure was desaturation, occurring in 26% of cases, and cough was the main post-bronchoscopy complication, occurring in 14% of cases 4.
• The use of bronchoscopy in pediatric oncology patients is considered safe, but it is essential to recognize and prevent potential complications, especially in patients with underlying chronic diseases or those who are at high risk for complications 2, 3, 4, 5.

Specific Complications and Risk Factors

• Mechanical complications of bronchoscopy are primarily related to airway manipulations or bleeding, while systemic complications arise from the procedure itself, medication administration, or patient comorbidities 5.
• The attributable mortality rates for bronchoscopy remain low, at less than 0.1% for fiberoptic and rigid bronchoscopy 5.
• The COVID-19 pandemic has resulted in safer bronchoscopy practice for all involved, with the use of personal protective equipment and other precautions to minimize the risk of transmission 6.

Bronchoscopy in Pediatric Patients

• Bronchoscopy is an essential procedure for evaluating, diagnosing, and treating pediatric respiratory diseases, including those with oncology conditions 4, 6.
• The indications for bronchoscopy in pediatric patients include foreign body aspiration, stridor, and consolidation, among others 4.
• The use of rigid bronchoscopy is often reserved for cases where foreign body aspiration is suspected, based on positive history, abnormal physical examination, and chest X-ray abnormalities 4.