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.