Abstract Introduction Bronchoscopic cryotherapy is an emerging diagnostic and therapeutic technique in pediatric airway management. Although interest among pediatric pulmonologists continues to grow, education and data regarding its indications, efficacy, and safety remain limited. This study describes the use of cryotherapy in pediatric interventional bronchoscopy at a single tertiary center to inform its clinical applications in this field and guide future practice. Methods We conducted a retrospective review of electronic medical records of pediatric patients (≤21 years) who underwent bronchoscopic cryotherapy between February and August 2025 at Lucile Packard Children’s Hospital. Demographic, clinical, and procedural data were collected, including indication, location, airway level, cryoprobe size, and complications. Descriptive statistics were used to summarize patient characteristics and procedural outcomes. Results A total of 18 procedures were performed in 11 unique patients with a mean age of 7.2 years. 8 patients (73%) were male. Indications for cryotherapy included obstructive blood clots (11, 61%), lymphatic plastic bronchitis (3, 17%), biopsy (3, 17%) and foreign body (1, 5%). Obstructive airway lesions were distributed in the trachea (N = 4), main bronchi (N = 4), and lobar/segmental bronchi (N = 5). Indications for biopsy included endobronchial mass (N = 1) and lymphadenopathy (N = 2). Procedures were most commonly performed in the cardiovascular intensive care unit (11, 61%), followed by the pediatric intensive care unit (1, 5%) and operating room (6, 33%). 3 patients (27%) were on ECMO at the time of their procedure. The median number of procedures per patient was 1 with an interquartile range of 1-2. The cryoprobe sizes used were 1.1 mm (N = 13, 72%), 1.7 mm (N = 0) and both (N = 5, 22%). The size was not documented in 1 (5%) case. The most common complication was minimal bleeding (6, 33%). No pneumothorax or severe bleeding was identified. No additional procedures were required to manage complications. Conclusion Bronchoscopic cryotherapy demonstrated versatile diagnostic and therapeutic utility in pediatric airway management across a range of indications, including airway obstruction, lymphatic plastic bronchitis, and endobronchial lesions. In this single-center experience, bronchoscopic cryotherapy was safely and effectively applied across multiple airway levels and age groups. Notably, cryotherapy was most commonly performed in the cardiac intensive care unit, a pattern that can help guide procedural planning and underscores the importance of including cryotherapy in pre-procedural discussions for high-risk patients. These findings support its feasibility and expanding role in pediatric interventional bronchoscopy. This abstract is funded by: None
Davala et al. (Fri,) studied this question.