THIS IS VERY MUCH A WORK IN PROGRESS AND WILL BE GREATLY EXPANDED AS TIME GOES ON...

Introduction

I began to perform flexible bronchoscopy in 1972, at a time when the smallest flexible bronchoscope was 6 mm in diameter, and pediatric flexible bronchoscopy was not feasible, except in adolescents. By late 1978, I had obtained the first prototype of a pediatric instrument - 3.7 mm in diameter, with 1.2 mm suction channel - and immediately discovered that it could be successfully and safely used in infants as small as 800 grams. Since that time, significant advances in instrumentation have enabled clinicians to explore and manipulate the airways of almost any child, with flexible instruments. Concurrent advances have been made in instrumentation for rigid bronchoscopy, and these two instruments/approaches are complimentary to each other.

This library is based on procedures done by me or my colleagues over a 5 decade career in pediatric bronchoscopy. The vast majority of the video clips are from patients seen at Cincinnati Children’s Hospital (CCHMC), which houses an archive of endoscopic videos extending back over the past several decades, and representing more than 50,000 procedures in more than 20,000 pediatric patients. Currently, more than 3,000 flexible bronchoscopies and more than 3,500 rigid bronchoscopies are performed at CCHMC annually. CCHMC is the world's largest center for pediatric airway surgery, and is the site of the first Aerodigestive Center, in which specialists from pediatric otolaryngology, pediatric pulmonology, pediatric gastroenterology, and pediatric surgery collaborate in the evaluation and management of children with complex airway and upper digestive problems. We have found that in many patients, neither flexible nor rigid bronchoscopes alone are sufficient for maximal patient benefit, and there is very substantial benefit in the concurrent use of both technologies in the same anesthetic session. Pediatric pulmonologists and otolaryngologists approach the airways from different perspectives, and having both participate in a patient evaluation and subsequent management is superior to either alone. Many of the videos in this library are taken from patients in the Aerodigestive program. In some cases, medical historical information accompanies the illustrative video clip(s); all such information has been completely anonymized. In many pediatric patients, the dynamics of the airways are important, and often, noisy breathing may be (among) the indication(s) for endoscopic evaluation. With few exceptions, however, no audio is included in these recordings; the viewer is encouraged to use a bit of imagination…

In many cases, the classification/placement of a specific video is arbitrary, and would be appropriate for more than one category, as there is more than one abnormality. I have attempted to avoid duplication, so please be gentle with me and just have fun exploring the library!

The airways and the esophagus arise from a common origin, and things that affect one can affect the other. While this library focuses on the airways, there are also selected videos from upper GI endoscopies to help pulmonologists and otolaryngologists better understand the interrelationship between the airway and the upper GI tract. There are times when a pulmonologist or otolaryngologist can and should examine the esophagus... especially if a pediatric gastroenterologist is not available.

The presentation of material in this library is intended as an adjunct to learning, not as a sole source of training in endoscopic techniques. The video clips have been edited to reduce the time required to view the important aspects and for clarity. Some have been subjected to minimal editing, leaving the secretions to obstruct the view some or even much of the time. As often as not, the tracheobronchial tree will need to be subjected to careful vacuum cleaning before the anatomic details can be discerned with clarity; I would not want the viewer to go away believing that the view is always optimal 😮 or that bronchoscopy is always as easy as it looks from optimized videos… Viewers will also notice that the color of the video images varies considerably - color rendering in videos is subject to many variables, some of which are out of my control. For example, in some of the videos, the bright red color could falsely suggest inflammation. Take the color differences in stride, and make no inferences unless so indicated in the presentations.

I am very much indebted to my colleagues for their contributions to this effort, including Drs. Dan Benscoter, Cherie Torres-Silva, Erik Hysinger, Gregory Burg, Sara Zak, John Brewington, Cori Daines, Paul Boesch and many others. Rigid endoscopy has been performed by my ENT colleagues, including Drs. Robin Cotton, Mike Rutter, Alessandro deAlarcon, Paul Willging, Catherine Hart, Christine Heubi, Charles Myer III, Charles Myer IV, David Smith, Matthew Smith and others. My GI collaborators have included Drs. Phil Putnam, Scott Pentiuk, James Rick, Ajay Kaul, and others. Carolyn Wallace, RRT, and Diana Betancur, RRT lead an exceptional team of respiratory therapists dedicated to the support of the bronchology program and have made all our work possible. The nurses who support our program play a critically important role. There are others, too numerous to mention here, who have been critical to the team effort that has resulted in this educational resource. The support of Holli Kunkel (Senior Business Director, Division of Pulmonary Medicine, and my very able Webmaster, Yuping Guo, has been crucial. My thanks to Dr. Raouf Amin, Director of the Division of Pulmonary Medicine, for his ongoing support and leadership.

Another resource for pediatric bronchology that may be of interest (this resource is also under development; it is a peer-reviewed site to which individuals may submit case reports with videos).  https://www.thoracic.org/members/assemblies/assemblies/peds/pediatric-flexible-bronchoscopy-library/

Copyright for the material in this library is held by Cincinnati Children’s Hospital. Website opened Dec 31, 2023