Perioperative management of plastic bronchitis in children

Abstract Purpose The aim of this study was to summarize clinical features and perioperative management of plastic bronchitis in 21 children. Methods We reviewed the clinical data of 21 children diagnosed with plastic bronchitis in our hospital from April 2001 to February 2009 in this retrospective study. Results Bronchoscopy was performed in 19 of the 21 cases. Of these, 13 patients were cured with the first procedure, during which branching bronchial casts were taken out. Six cases required a second procedure; of these, five patients were cured by removing branching bronchial casts; one patient died from massive pulmonary hemorrhage during anesthesia induction. Two patients were critically ill at initial diagnosis and worsened despite airway intubation, these patients died of multiple organ failure. The branching bronchial casts which were composed primarily of gelatinous fibers were sent for pathologic examination. Pathologically, 12 foreign bodies were classified as type I casts (containing inflammatory cells), 9 cases were type II (no inflammatory cells detected). Conclusions Plastic bronchitis in children is a life-threatening disease, the only effective therapeutic modality is bronchoscopic extraction. The early diagnosis of plastic bronchitis is difficult, anesthesia and extraction procedures are demanding, and the postoperative monitoring is challenging. The clinician should try to make an early diagnosis, use enhanced perioperative monitoring, and improve operational technique to provide timely treatment for the children with plastic bronchitis, thereby reducing the associated mortality rate.