The effects of flexible bronchoscopy on mechanical ventilation in a pediatric lung model

Danny Hsia, Robert M. DiBlasi, Peter Richardson, David Crotwell, Jason Debley, Edward Carter

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Flexible bronchoscopy performed through endotracheal tubes (ETTs) in children receiving mechanical ventilation can significantly impact ventilation, but the magnitude of this impact has not been established. We used a lung model to simulate mechanical ventilation in a range of child sizes in order to determine how the insertion of pediatric flexible bronchoscopes into ETTs alters ventilatory parameters, especially tidal volume (VT) and peak inspiratory pressure (PIP), in both healthy and diseased lungs. Methods: We simulated five child sizes based on weight, and evaluated 22 bronchoscope/ETT combinations, first in pressure control (PC) ventilation mode and then in volume control (VC) ventilation mode. The combinations ranged from the 2.2-mm (bronchoscope outer diameter)/3.0-mm (ETT inner diameter) to 5.0-mm bronchoscope/8.0-mm ETT. The primary outcome measures were decrease in VT after bronchoscope insertion during PC ventilation and increase in PIP during VC ventilation. Results: In the PC ventilator mode, VT decreased by > 50% with nine of the combinations, while during VC ventilation, PIP increased by ≥ 20 cm H2O with seven combinations. The 2.2-mm bronchoscope/3.0-mm ETT, 2.8-mm bronchoscope/5.0-mm ETT, and 3.6-mm bronchoscope/5.0-mm ETT combinations severely impaired ventilation, while the 3.6-mm bronchoscope/4.5-mm ETT, 5.0-mm bronchoscope/6.5-mm ETT, and 5.0-mm bronchoscope/7.0-mm ETT combinations were incompatible with adequate ventilation. Conclusions: The insertion of bronchoscopes into ETTs can lead to clinically relevant decreases in VT when in the PC ventilator mode and large increases in PIP during VC ventilation. The minimum bronchoscope/ETT diameter difference required to maintain adequate ventilation increases with child size.

Original languageEnglish (US)
Pages (from-to)33-40
Number of pages8
JournalChest
Volume135
Issue number1
DOIs
StatePublished - Jan 2009
Externally publishedYes

Fingerprint

Bronchoscopes
Bronchoscopy
Artificial Respiration
Pediatrics
Ventilation
Lung
Pressure
Mechanical Ventilators
Tidal Volume
Lung Diseases

Keywords

  • Children
  • Flexible bronchoscopy
  • Mechanical ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Hsia, D., DiBlasi, R. M., Richardson, P., Crotwell, D., Debley, J., & Carter, E. (2009). The effects of flexible bronchoscopy on mechanical ventilation in a pediatric lung model. Chest, 135(1), 33-40. https://doi.org/10.1378/chest.08-1000

The effects of flexible bronchoscopy on mechanical ventilation in a pediatric lung model. / Hsia, Danny; DiBlasi, Robert M.; Richardson, Peter; Crotwell, David; Debley, Jason; Carter, Edward.

In: Chest, Vol. 135, No. 1, 01.2009, p. 33-40.

Research output: Contribution to journalArticle

Hsia, D, DiBlasi, RM, Richardson, P, Crotwell, D, Debley, J & Carter, E 2009, 'The effects of flexible bronchoscopy on mechanical ventilation in a pediatric lung model', Chest, vol. 135, no. 1, pp. 33-40. https://doi.org/10.1378/chest.08-1000
Hsia, Danny ; DiBlasi, Robert M. ; Richardson, Peter ; Crotwell, David ; Debley, Jason ; Carter, Edward. / The effects of flexible bronchoscopy on mechanical ventilation in a pediatric lung model. In: Chest. 2009 ; Vol. 135, No. 1. pp. 33-40.
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abstract = "Background: Flexible bronchoscopy performed through endotracheal tubes (ETTs) in children receiving mechanical ventilation can significantly impact ventilation, but the magnitude of this impact has not been established. We used a lung model to simulate mechanical ventilation in a range of child sizes in order to determine how the insertion of pediatric flexible bronchoscopes into ETTs alters ventilatory parameters, especially tidal volume (VT) and peak inspiratory pressure (PIP), in both healthy and diseased lungs. Methods: We simulated five child sizes based on weight, and evaluated 22 bronchoscope/ETT combinations, first in pressure control (PC) ventilation mode and then in volume control (VC) ventilation mode. The combinations ranged from the 2.2-mm (bronchoscope outer diameter)/3.0-mm (ETT inner diameter) to 5.0-mm bronchoscope/8.0-mm ETT. The primary outcome measures were decrease in VT after bronchoscope insertion during PC ventilation and increase in PIP during VC ventilation. Results: In the PC ventilator mode, VT decreased by > 50{\%} with nine of the combinations, while during VC ventilation, PIP increased by ≥ 20 cm H2O with seven combinations. The 2.2-mm bronchoscope/3.0-mm ETT, 2.8-mm bronchoscope/5.0-mm ETT, and 3.6-mm bronchoscope/5.0-mm ETT combinations severely impaired ventilation, while the 3.6-mm bronchoscope/4.5-mm ETT, 5.0-mm bronchoscope/6.5-mm ETT, and 5.0-mm bronchoscope/7.0-mm ETT combinations were incompatible with adequate ventilation. Conclusions: The insertion of bronchoscopes into ETTs can lead to clinically relevant decreases in VT when in the PC ventilator mode and large increases in PIP during VC ventilation. The minimum bronchoscope/ETT diameter difference required to maintain adequate ventilation increases with child size.",
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