Objectives: To determine the diagnostic and therapeutic value of flexible fiberopticbronchoscope in critical children, characteristics of the children who will need theprocedure and its impact on the patient outcome in a Paediatric Intensive Care Unit(PICU). Methods and Results: Prospective observational study over one yearincluded 32 Egyptian children (age: 1 month to 12 years old ) hospitalized in PICUwith persistent pulmonary symptoms were included. Mucus plugging and airwayinflammation were the most common findings of the patients. BAL in thepatients with inflammation and infection secondary to ventilator associatedpneumonia had a sensitivity of 100 % in comparison to both blood and sputumcultures. Also, patients less than 2 years of age required less ventilation days and less mortality ; but the P value was only approaching statistical significance as regardingtheir PICU outcome ( p value= 0.07), this signifies how the FFB procedure could effectively shorten the ventilation days in those with acute illness. Sixteen percent was the mortality rate as a final outcome of the study group compared to totalmortality of 30% to the PICU population in the same period, and the only significantfactor in the comparison between mortality and discharged groups was the relativelylower platlate count ( 155 + 80) v.s (343 + 180) (p.value 0.034). Conclusion: Theflexible fiberoptic procedure can be safely and effectively used for diagnostic as wellas therapeutic purposes for patients admitted to pediatric ICU and could effectivelyresolve persistant pulmonary infiltrates and BAL could target a better antibioticchoice . The FFB also had a role of improving the outcome of infants in the PICU