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OBJECTIVES To study the utility, safety and effects of flexible fiberoptic bronchoscopy (FFB) on oxygenation status, ventilation parameters and hemodynamics in mechanically ventilated children. DESIGN Retrospective study PATIENTS: Children age > 1month to 18 years suffering with critical medical and surgical diseases. RESULTS First bronchoscopy data of 131 patients was analysed. Indication, FFB findings, microbiological yield from bronchoalveolar lavage and medical and surgical interventions based on FFB results were recorded. Hemodynamic and ventilation parameters before, during and 3 hours after FFB were also captured. Majority of bronchoscopies were done for diagnostic purpose with positivity rate of 90.8%. Retained mucopurulent secretion in airways was the commonest finding in 60 patients. A cause for weaning or extubation failure could be identified in 83.3%. Post FFB radiological resolution of atelectasis was seen in 34/59 (57.6%; P value 0.001) chest radiographs. 47 medical and 25 surgical interventions were done depending on FFB and BAL findings. There was significant drop in oxygenation parameters and rise in heart rate during FFB (P value <0.0001). The peak inspiratory pressure, positive end-expiratory pressure and mean airway pressure increased significantly during bronchoscopy (P value <0.0001) while patients were on pressure regulated volume controlled ventilation. All these changes reversed to pre FFB levels. There were minor procedure related complications. CONCLUSION FFB was an important diagnostic and therapeutic tool for mechanically ventilated children and the results helped in planning the interventions. It was a safe procedure with transient reversible cardiopulmonary alterations. This article is protected by copyright. All rights reserved.