Results
We emailed the survey to 256 members of respiratory chapter of IAP
including personal contacts and 336 to members of Indian Chest Society.
There were 48 and 89 wrong emails for respiratory chapter of IAP and
members of Indian Chest Society respectively. Seven replied that they
were not doing pediatric flexible bronchoscopy. We received a total of
27 completed survey. Out of these, three were from outside India (two
from United Kingdom and one from Nepal) and were excluded. We included
24 responses from India for this study.
Demographic profile : It is shown in Table 1. All except one had
right had as dominant hand. Maximum [9, (37.5%)] were from Delhi,
three (12.5%) from Jodhpur (Rajasthan) and remaining 12 were one each
from 12 different cities of India including Pune (Maharashtra), Mumbai
(Maharashtra), Lucknow (Uttar Pradesh), Kanpur (Uttar Pradesh),
Coimbatore (Tamilnadu), Srinagar (Jammu and Kashmir), Bangalore
(Karnataka), Eluru (Andhra Pradesh), Vijayawada (Andhra Pradesh), Mandi
(Himachal Pradesh), and Thiruvalla (Kerala). Name of city was missing in
one response.
The median (IQR) number of years for which bronchoscopist were
performing pediatric bronchoscopy was 3.5 (2,8) years with a range of
one year to 28 years. Fourteen (58.3%) had experience of less than 5
years, 3 (12.5%) each had an experience of 5-10 years and more than 10
years. The median (IQR) number of total bronchoscopy and bronchoscopy in
last one year was 75 (25, 428) and 25 (15,45) respectively with range of
10 to 1000 and 5 to 230 respectively. Six (25%) were also doing
bronchoscopy in adults and four (16.7%) were also doing rigid
bronchoscopy. Three (12.5%) were performing endobronchial Ultrasound
(EBUS).
Patient preparation and monitoring: The patient preparation and
monitoring details are summarized in Table 2. All the respondents took
written informed consent and filled checklist for bronchoscopy. There is
high variability in use of drugs for patient preparation (Table 2).
Sedation/anesthesia (Table 2): Pre-procedure institution of
xylocaine was universal but the site of instillation differed. Mostly
used conscious sedation, but choice of sedative agents and person
administering the sedation varied markedly (Table 2).
Procedural aspects (Table 3): Mostly held the bronchoscope in
left hand and stood behind the patient while performing the
bronchoscopy. Oxygen was routinely supplemented by most but the method
of delivering oxygen was variable (Table 3). The quantity of saline used
for BAL was also variable ranging from fixed 5 ml or 1 ml to 2 ml/kg and
number of aliquots also varied from 2 to 6 aliquots (Table 3). Type of
assistant varied from trained pediatric pulmonologist or trained nurse
or pediatric resident or a fellow or lab technician or anesthetist.
Bronchoscope cleaning and disinfection (Table 4): Again, there
was wide variation in doing cleaning of bronchoscope, frequency of leak
test, duration of disinfection and storage of the bronchoscope (Table
4).
Post procedure monitoring was done till child regains full consciousness
by 18 (75%) respondents. The approximate rate of overall complication
was reported to be <5%. Most common complications observed
were transient desaturations, bleeding from nose, tachycardia and
tachypnea.