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Background: Flexible airway endoscopy (FAE) is an accepted and frequently performed procedure in the evaluation of children with known or suspected airway and lung parenchymal disorders. However, published technical standards on how to perform FAE in children are lacking.
Methods: The American Thoracic Society (ATS) approved the formation of a multidisciplinary committee to delineate technical standards for performing FAE in children. The committee completed a pragmatic synthesis of the evidence and used the evidence synthesis to answer clinically relevant questions.
Results: There is a paucity of randomized controlled trials in pediatric FAE. The committee developed recommendations based predominantly on the collective clinical experience of our committee members highlighting the importance of FAE-specific airway management techniques and anesthesia, establishing suggested competencies for the bronchoscopist in training, and defining areas deserving further investigation.
Conclusions: These ATS-sponsored technical standards describe the equipment, personnel, competencies, and special procedures associated with FAE in children.
THESE OFFICIAL TECHNICAL STANDARDS OF THE AMERICAN THORACIC SOCIETY (ATS) WERE APPROVED BY THE ATS BOARD OF DIRECTORS,JANUARY 2015
Contents
Overview
Conclusions
Methods
Equipment and Procedural Setting
Infection Control
Training
Common Reasons for Performing Flexible Airway Endoscopy
Preprocedure Evaluation
Sedation and Monitoring
Airway Management and Examination
The Role of the Rigid Bronchoscope
BAL
Performance
Processing
Diagnostic Utility of BAL
Infection
BAL in CF
BAL in the Diagnosis of Pulmonary Aspiration
BAL in Other Disorders
Specialized Procedures
Atelectasis
Documentation
Conclusions and Future Directions
Overview
To update the American Thoracic Society (ATS) Official Statement on Flexible Endoscopy of the Pediatric Airway, the ATS sponsored the development of technical standards for the performance of pediatric flexible airway endoscopy (FAE). To complete this effort, an international, multidisciplinary committee comprehensively reviewed the literature and developed this report, including an online supplement in which we describe select topics in more detail.
Conclusions
* Equipment and setting
* The number and type of bronchoscopes required at any individual institution is determined by each institution's understanding of the anticipated number of procedures. This is based on the characteristics of its patient population and typical indications for FAE. In addition, this number should reflect the facility's ability to clean and disinfect the equipment in a timely fashion.
* The appropriate setting for FAE is determined by the patient's clinical condition, facilitates patient safety, allows...