Bronchoscopy in Pediatric Cardiac Surgery Patients: Airway Findings, Clinical Outcomes, and the Selective Role of Rigid Bronchoscopy

BackgroundThis study evaluated the indications, airway findings, therapeutic interventions, and clinical outcomes associated with bronchoscopy in pediatric cardiac surgery patients, including the selective role of rigid bronchoscopy.MethodsThis retrospective, single-center study included patients who underwent bronchoscopy between January 2019 and January 2025. Among 1840 surgical patients, 60 required bronchoscopy because of prolonged mechanical ventilation, extubation failure, difficulty weaning from ventilatory support, or suspected airway pathology.ResultsThe median age of the patients was 9 months, and the first bronchoscopy was performed at a median of 8.5 postoperative days (range, 5-24 days). Findings were normal in 32/60 patients (53.3%). The most common abnormalities were mucus plugging/secretion retention (20.0%, 12/60), blood clots (8.3%, 5/60), and tracheomalacia (8.3%, 5/60). Thirteen patients underwent 16 rigid bronchoscopic procedures. Bronchoscopy guided subsequent management, including diaphragmatic plication in four patients and surgery for bronchial compression in three. Among 17 patients with mucus plugging/secretion retention or blood clot, eight achieved successful extubation without tracheostomy. Tracheostomy was performed in 34/60 patients (56.7%), and in-hospital mortality in this group was 28.3% (17/60). Brief transient oxygen desaturation occurred occasionally, but no major procedure-related complications were observed.ConclusionsBronchoscopy provides clinically useful diagnostic and therapeutic information in selected pediatric cardiac surgery patients. Mucus plugging or retained secretions were the most common abnormal finding, while normal findings helped redirect evaluation toward alternative causes of ventilator dependence. Flexible bronchoscopy was adequate for most patients, whereas rigid bronchoscopy was reserved for selected cases of dense mucus plugs or organized blood clots that could not be adequately removed with flexible techniques.