Abstract Rationale Upper respiratory infections (URIs) are a frequent reason for postponing pediatric elective bronchoscopies due to perceived risk of perioperative respiratory complications. Symptomatic infections are known to carry a risk of increased adverse events, however limited data exists regarding asymptomatic viral detection in children undergoing elective airway procedures. We evaluated whether incidental detection of viral infection on bronchoalveolar lavage (BAL) in asymptomatic patients is associated with increased hospital admission or post-procedural complications. Methods We performed a retrospective cohort study of children aged 0-21 years undergoing elective outpatient bronchoscopy with BAL at a free-standing pediatric hospital between March 2023 and March 2025. Respiratory pathogen panel (RPP) testing via PCR was performed on BAL samples. The primary outcome was post-procedure hospital admission (planned or unplanned). Secondary outcomes included need for respiratory support, delayed extubation, and ICU admission. Demographic, clinical, and procedural data were extracted from the electronic medical record. Results Among 189 children (mean age 6.5 yrs), 38.% had a positive RPP. The most commonly detected pathogens were human rhinovirus/enterovirus (54%), coronavirus (14%), and adenovirus (10%). The most common comorbidities were asthma (41%), aspiration/dysphagia (19%), and anatomic airway abnormalities (14%). The most common indications for the procedure were chronic cough (56%), infection surveillance (14%), and abnormal imaging (14%). Nine patients (5%) required post-procedural hospital admission; five were planned and four were unplanned. The average length of stay was one day (range 1-5 days). Among unplanned admissions, 75% were RPP-negative. The RPP-positive patient had a history of recurrent pneumonia and required hospitalization for acute hypoxemic respiratory failure. Conclusions In this cohort of pediatric patients undergoing elective bronchoscopy, asymptomatic viral detection was common but not associated with increased post-procedural respiratory complications or hospital admission. These findings suggest that children who are clinically recovered from recent respiratory infections but remain RPP-positive may safely proceed with elective bronchoscopy under appropriate perioperative evaluation. Decision making should prioritize clinical assessment over RPP test results alone. Prospective studies are warranted to validate these findings and refine perioperative management guidelines. This abstract is funded by: None
Bokaee et al. (Fri,) studied this question.
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