Optimizing nursing interventions and identifying prognostic factors for airway complications in pediatric bronchoscopy

This study aimed to evaluate the incidence and severity of post-bronchoscopy airway complications in pediatric patients, assess the impact of targeted nursing interventions, and identify prognostic risk factors, including procedure-related thresholds, influencing postoperative recovery. A retrospective cohort study was conducted on 216 pediatric patients who underwent flexible bronchoscopy at a tertiary referral center from February 2023 to February 2025. Airway complications, including hypoxemia (SpO₂ <90%), bronchospasm, laryngeal edema, aspiration pneumonia, and pneumothorax, were systematically recorded. Nursing interventions such as pre-procedural nebulization therapy, intraoperative oxygen supplementation strategies, and post-procedural airway management were evaluated. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed to identify independent predictors and clinically relevant cut-off values for severe complications. Of the 216 patients, 76 (35.19%) developed at least one airway complication. The most common events were transient hypoxemia (29.63%, n = 64), bronchospasm (12.50%, n = 27), and laryngeal edema (9.72%, n = 21), while severe outcomes such as aspiration pneumonia (3.70%) and pneumothorax (0.93%) were rare. Pre-procedural nebulization significantly reduced bronchospasm incidence (9.17% vs. 16.67%, p = 0.027). Subgroup analysis revealed no significant difference between salbutamol and budesonide (p > 0.05), though saline aerosols were not evaluated. Patients with laryngeal edema had a markedly higher need for oxygen supplementation compared with those without (85.71% vs. 28.21%, p < 0.001). Multivariate analysis identified younger age (OR = 1.41, 95% CI: 1.12–1.77, p = 0.003), pre-existing respiratory disease (OR = 2.18, 95% CI: 1.39–3.42, p = 0.001), and prolonged procedure duration (OR = 1.26, 95% CI: 1.08–1.47, p = 0.004) as independent risk factors. ROC analysis further indicated a cut-off of 7 min for procedure duration, above which the risk of severe complications increased significantly (18.6% vs. 7.2%, p = 0.003). Airway complications following pediatric bronchoscopy are frequent in high-risk populations, with most events being transient but clinically relevant. Individualized nursing interventions—particularly standardized pre-procedural nebulization and optimized oxygenation strategies—can effectively reduce complication rates. Younger age, pre-existing respiratory disease, and prolonged procedure duration (especially beyond 7 min) are key prognostic factors. These findings underscore the importance of risk stratification and structured perioperative nursing protocols to enhance safety and optimize recovery in pediatric bronchoscopy.