The Evaluation of the Upper and Lower Airways in Infants and Children: Principles and Pearls from Four Decades in the Trenches

Abstract

Diagnostic bronchoscopy is an often underutilized technique in pediatric patients. However, with proper equipment, appropriate technical and cognitive skills, and effective and careful attention to safety and comfort, bronchoscopy can be a powerful tool for the pediatric pulmonologist. This review is a distillation of the author's four decades of experience. Keywords Flexible bronchoscopy • Airway dynamics • Sedation/anesthesia for pediatric bronchoscopy • Airway management for pediatric fl exible bronchoscopy • Indications for pediatric fl exible bronchoscopy • Complications of pediatric fl exible bronchoscopy • Techniques for pediatric fl exible bronchoscopy • Clinical utility of pediatric fl exible bronchoscopy Bronchoscopy is a powerful diagnostic and therapeutic tool for the evaluation and management of children with pulmonary or airway issues. During the 1970s, dra-matic progress was made in the development of instrumentation suitable for pediat-ric bronchoscopy, including the glass rod telescope for rigid instruments and a fl exible bronchoscope small enough to be safely used in children. Over the ensuing nearly four decades, further progress has been made in instrumentation as well as experience in the utilization of these instruments.