Department of Endoscopic diagnostics

Head of department
Željka Vlašić Lončarić, MD, PhD

Department's main nurse
Danijela Vrankić, dipl. med. techn.

bronhoskopija 2

In our facility is available flexible and rigid bronchoscopy for the entire pediatric population (0-18 years), which is performed in state-of-the-art operating room. With the latest technology (Olympus Exera III, Karl Storz rigid bronchoscopy system). All procedures are performed in general anesthesia, thus achieving a high level of quality in diagnostics and treating our small patients.

Bronchoscopy is an invasive diagnostic and therapeutic procedure. Using bronchoscopy in indicated clinical cases it is possible to solve the differential diagnosis dilemmas and to get a precise diagnosis. Also in certain conditions, therapeutic bronchoscopy enhances and enables to cure the sick children.

Bronchoscopy is an invasive diagnostic and therapeutic procedure that allows a direct and dynamic examination of the respiratory system using an endoscope. It allows direct visualization of the inside respiratory tract with possible functional assessment of respiratory tract mobility during breathing.
The size of the bronchoscope depends on the age of the child, the size of the endotracheal tube (if the child has it) through which the bronchoscope retracts and also on necessary diagnostic therapeutic procedures.

Indications for Flexible Bronchoscopy in Children:

  1. 1. Stridor - long lasting, doesn't respond to therapy, from birth
    2. Wheezing – long lasting, doesn't respond to therapy
    3. Chronic cough - longer than 6-8 weeks
    4. Repetitive diseases – pneumonia, bronchitis
    5. Recurring or persistent findings on lung radiogram - inflammation, atelectasis
    6. Suspicion of foreign body inhalation - used in detection of a foreign body, extraction is performed by a rigid bronchoscope
    7. Collection of specimens in suspicion of tuberculosis - mainly in young children who can't give sputum or in case of major radiological changes with possible compression of the airway. Treatment of hemoptysis - determination of position and extent of bleeding, stopping the bleeding
    8. Evaluation of tracheostomy - especially in premature babies in intensive care units
    9. Evaluation of specific lung diseases - interstitial lung disease (pulmonary hemorrhage, alveolar proteinosis, sarcoidosis) - with the use of appropriate diagnostic materials
    10. The need for therapeutic interventions – cleaning of respiratory tract, secretion cleansing and lung rinsing (in premature babies, atelectasis, cystic fibrosis, ciliary dyskinesia)
    11. Lung inflammation - severe pneumonia that does not respond to therapy or pneumonia in immunocompromised children - collection of material for microbial analysis.

Performing Flexible Bronchoscopy:

1. No oral intake 4-6 hours prior to the procedure

a. 6 hours of solid food
b. 6 hours of dairy formulas and porridge
c. 4 hours of breast milk
d. 2 hours of clear liquid

2. Placing an intravenous route with compensation of liquid
3. Premedication
4. Sedation or general anesthesia with pulse and saturation monitoring and ECG

a. Sedation- depresses less the breathing and provides better insight into the dynamics of spontaneous breathing in the upper and lower respiratory tracts (laryngeal tracheal bronchomalacia, vocal dysfunction)
b. General anesthesia – depresses deeper breathing and cough, makes it easier to look at the respiratory tract due to less movement but more difficult to estimate functional respiratory disturbances

5. Performing bronchoscopy and collection of materials and adequate storage for further transport to the laboratory and analysis:

a. Aspirate (aerobic, anaerobic)
b. Bronchoalveolar lavage (BAL)
c. Brush biopsy
d. Endobronchial Biopsy (EBB)
e. Transbronchial Biopsy (TBB)

6. Intensive monitoring in the recovery period from anesthesia
7. No oral intake 1-3 hours after surgery
8. Observation 24 hours after surgery due to possible complications and side effects

a. Oxygen saturation fall
b. Cough
c. Wheezing
d. Epistaxis
e. A one-time temperature rise within 24 hours - when performing BAL
f. Laryngospasm / bronchospasm
g. Hemoptysis - by EBB and TBB
h. Pneumothorax - by TBB

Flexible bronchoscopy in children is a safe and minimal traumatic invasive procedure with a small number of possible complications. It is performed in specialized institutions that provide adequate place and equipment with high level of expertise.
Parents' stay with the child before and after the bronchoscopy and psychological preparation of the child by the parents are essential components of the successful procedure. That makes the procedure with the smallest trauma for the child.

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