Comparing two models for rigid bronchoscopy and foreign body retrieval training

The COVID-19 pandemic has resulted in a significant increase in the number of tracheostomised patients in hospitals requiring ventilatory support. These patients require highly specialist care, but overwhelmed hospital systems with stretched human resources potentially leave these patients cared for by undertrained healthcare professionals. We describe a rare complication where a routine COVID-19 swab done incorrectly via a tracheostomy tube, resulted in a snapped-off swab in the trachea. We outline the events and our method of removal using rigid bronchoscopy through the tracheostomy stoma as endo-tracheal bronchoscopy was impossible due to significant sub-glottic stenosis. This case highlights the paramount importance of the unique care needed to safely manage tracheostomies during this ongoing pandemic.

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Foreign body retrieval by rigid bronchoscopy in children - A comparative study of spontaneous ventilation Vs controlled ventilation

MedPulse International Journal of Anesthesology ◽

10.26611/10151333 ◽

2020 ◽

Vol 13 (3) ◽

pp. 149-153

Author(s):

Natasha Gupta ◽

◽

B Sanjeevkumar ◽

Madiha Shadab ◽

Umesh Kumar Badani ◽

...

Keyword(s):

Foreign Body ◽

Comparative Study ◽

Rigid Bronchoscopy ◽

Spontaneous Ventilation ◽

Foreign Body Retrieval ◽

Controlled Ventilation

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Clinical analysis of tracheobronchial foreign body aspiration in children: a focus on external and intrinsic factors

BMC Surgery ◽

10.1186/s12893-021-01089-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Weigang Gan ◽

Ning Xiao ◽

Yiyuan Feng ◽

Danmei Zhou ◽

Juanjuan Hu ◽

...

Keyword(s):

Foreign Body ◽

Pediatric Patients ◽

Treatment Delay ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

External Factors ◽

Factors Affecting ◽

Intrinsic Factors ◽

Common Location ◽

Tracheobronchial Foreign Body

Abstract Background Tracheobronchial foreign body aspiration (TFBA) is a critical disease in children and is extremely dangerous, even life-threatening. The factors affecting the occurrence and prognosis of TFBA are complex. The purpose of this study is to examine the external and intrinsic factors affecting clinical features of TFBA in West China and propose potential effective intervention measures. Methods We retrospectively analyzed the clinical data of pediatric patients diagnosed with TFBA with foreign bodies (FBs) removed by rigid bronchoscopy under general anesthesia at the otolaryngology department from December 2017 to November 2018. The data included age, sex, clinical symptoms, type and location of FB, guardians, prehospital duration and residence of these pediatric patients. Results The ratio of males (72) to females (53) was 1.4:1. Children aged from 1 to 3 years accounted for 76% (95/125) of patients. Cough, continuous fever and dyspnea were the primary symptoms. The right primary bronchus was the most common location of FB detection by rigid bronchoscopy (67 cases, 53.6%). Organic FBs were most common in our study. Guardians of patients significantly differed in the rural (parents 16, grandparents 31) and urban (parents 52, grandparents 26) groups (χ2 = 12.583, p = 0.000). More children in the rural group than in the urban group had a treatment delay longer than 72 h. More children in the group with no history of FB aspiration (12, 25%) than in the group with prior FB aspiration had a treatment delay longer than 72 h. Conclusion Pediatric TFBA is a common emergency in otolaryngology. Age, sex, tracheobronchial anatomy and other physiological elements were defined as intrinsic factors, while guardians, residence, FB species and prehospital time were defined as external factors of TFBA. External and intrinsic factors both influence the occurrence and progression of TFBA. It is extremely important to take effective measures to control external factors, which can decrease morbidity and mortality.

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Challenges in Management of Tracheobronchial Foreign Bodies with Delayed Presentation: An Institutional Experience

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1718964 ◽

2021 ◽

Author(s):

Darwin Kaushal ◽

Amit Goyal ◽

Kapil Soni ◽

Bikram Choudhury ◽

Nithin Prakasan Nair ◽

...

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Preoperative Planning ◽

Rigid Bronchoscopy ◽

Delayed Presentation ◽

Betel Nut ◽

Key Factors ◽

Tracheobronchial Foreign Body ◽

Institutional Experience ◽

Definitive Management

Abstract Introduction Airway foreign bodies are emergencies involving multidisciplinary departments like Pediatrics, Aneasthesiology and Otorhinolaryngology. It is always a challenge to diagnose and manage patients who present late to our emergencies. Objective In the present study, we aim to analyze the various challenges faced during the management of tracheobronchial foreign bodies with delayed presentation. Methods A retrospective hospital record-based analysis of patients who presented to us with tracheobronchial foreign bodies from January 2017 to February 2020 was performed. All patients until the age of 16 years old were included in the present study. We assessed the demographics, preoperative, intraoperative and postoperative data of the patients. Results Seventeen patients were analyzed in the study. Among these, 44.4% of the patients had delayed presentation (> 1 month). The majority of the patients had an organic foreign body (Supari or betel nut). All patients underwent rigid bronchoscopy, followed by optical forceps-assisted removal of the foreign body. A total of 82% of the patients had granulations around the foreign body. Conclusion Management of delayed presentation tracheobronchial foreign body is a big challenge for Otorhinolaryngologists. The key factors for preventing complications in the definitive management of tracheobronchial foreign bodies are preoperative planning, multi-discipline teamwork, surgeon expertise and technique.

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Foreign Body Removal: Tracheal Backflow Air or Rigid Bronchoscopy?

Anesthesia & Analgesia ◽

10.1097/00000539-200011000-00056 ◽

2000 ◽

Vol 91 (5) ◽

pp. 1309

Author(s):

Si-Tun Fung

Keyword(s):

Foreign Body ◽

Rigid Bronchoscopy ◽

Foreign Body Removal

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Rigid ventilating video bronchoscope with forceps for bronchoscopic foreign body removal in children

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192746 ◽

2019 ◽

Vol 5 (4) ◽

pp. 1129

Author(s):

Sagar Jawale ◽

Parthapratim Gupta ◽

Bharti Kulkarni

Keyword(s):

Foreign Body ◽

Gold Standard ◽

Medical Literature ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Indian Children ◽

Foreign Body Removal ◽

Rigid Tube ◽

Pass Through ◽

First Time

<p>Bronchoscopic foreign body removal is a potentially dangerous and challenging procedure in pediatric surgery. bronchoscopy under general anaesthesia is the gold standard of diagnosis and management of foreign body aspiration. A large ventilating channel and better control over the tip of the instrument and cheaper instrument are the merits of rigid bronchoscopy over flexible one. Traditionally a rigid tube alone is used for this purpose which has extreme limitations of vision and it is risky. Foreign body aspiration typically occurs in 6 to 18 month age and the size of glottis is very small at this age. In Indian children who are small and malnourished the large assembly of sheath and telescope mounted forceps does not pass through the glottis. To overcome the limitations of the traditional equipment I designed my own bronchoscopy equipment by my 15 year of experience in bronchoscopy. This type of device is reported for the first time in medical literature and patent is filed for it at Mumbai office.</p><p> </p>

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Occult Foreign Body Aspirations in Pediatric Patients: 20-years of Experience

10.21203/rs.3.rs-41995/v3 ◽

2020 ◽

Author(s):

Bo Liu ◽

Fengxia Ding ◽

Yong An ◽

Yonggang Li ◽

Zhengxia Pan ◽

...

Keyword(s):

Foreign Body ◽

Medical Records ◽

Foreign Bodies ◽

Pediatric Patients ◽

Previous History ◽

Rigid Bronchoscopy ◽

Diagnostic Difficulties ◽

History Of ◽

Male Patients ◽

Symptoms And Signs

Abstract Background: The purpose of our study was to assess the frequency of occult foreign body aspiration (FBA) and to evaluate the diagnostic difficulties and therapeutic methods for these patients. Methods: Between May 2000 and May 2020, 3557 patients with the diagnosis of FBA were treated in our department. Thirty-five patients with occult FBA were included in this study. A retrospective analysis of medical records was performed. Results: Twenty-three male patients (65.7%) and 12 female patients (34.3%) were hospitalized due to occult FBA. The average age was 3.60 years (range 9 months-12 years). Most of the patients were younger than 3 years old (n=25, 71.4%). Coughing (n=35, 100%) and wheezing (n=18, 51.4%) were the main symptoms and signs. All the patients were found to have a FBA under the fiberoptic bronchoscope. The most common organic foreign bodies were peanuts (n=10) and the most common inorganic foreign bodies were pen caps (n=5). The extraction of foreign bodies under rigid bronchoscopy was applied successfully in 34 patients. Only one patient needed a surgical intervention. Conclusions: Occult FBA should always be considered in the differential diagnosis of chronic or recurrent respiratory diseases that are poorly explained, even in the absence of a previous history of aspiration.

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Tracheobronchial foreign body aspiration in children: a 5-year retrospective study from Shanghai, China

10.21203/rs.2.11329/v1 ◽

2019 ◽

Author(s):

Guodong Ding ◽

Beirong Wu ◽

Angela Vinturache ◽

Chen Cai ◽

Min Lu ◽

...

Keyword(s):

Foreign Body ◽

Descriptive Analysis ◽

Sudden Onset ◽

Rigid Bronchoscopy ◽

Flexible Bronchoscopy ◽

Older Children ◽

Female Ratio ◽

X Ray ◽

Presenting Symptoms ◽

First Choice

Abstract Background Foreign body (FB) aspiration is a common and serious problem in childhood, but little information is available about this condition in Chinese context. We aimed to characterize the clinical and epidemiological features of airway FBs in a pediatric Chinese population. Methods A retrospective review of medical records of children aged 0-14 years who attended with a diagnosis of FB aspiration the Shanghai Children's Hospital between 2013 and 2017 was carried out. Descriptive analysis was used to assess patient's demographics, clinical, radiographic, bronchoscopic findings, time to presentation, and characteristics of the FBs. Results Among the 200 patients included in the study, 92% were under 3 years of age, with a peak incidence of FB aspiration occurring between 1 and 2 years. The male to female ratio was 2.6:1. Twenty-three percent of the patients were admitted within 24 hours of the event, 40% within 1 week, 30% within 1 month, and 7% more than 1 month after aspiration. Eleven percent were laryngotracheal FBs and 89% were bronchial FBs. The most common presenting symptoms of laryngotracheal FBs were cough, dyspnea, and wheezing; those of bronchial FBs were cough, decreased air entry, and wheezing. Chest X-ray was normal in four-fifths of the children with laryngotracheal FBs, whereas most common abnormal x-ray findings in children with bronchial FBs were mediastinal shift, obstructive emphysema, and pneumonia. In children younger than 2 years FBs were more frequently found in the left bronchus, whereas in older children FBs were more frequently found in the right bronchus. Ninety-three percent of the removed FBs were organic materials such as food items and the most frequently aspirated FBs were peanuts. Flexible bronchoscopy was successfully performed in 80.5% of the patients, while rigid bronchoscopy or direct laryngoscopy in 17.5% of the patients. Four patients were subjected to thoracic surgery and 1 died during bronchoscopy due to acute respiratory failure. Conclusions Tracheobronchial FBs should be suspected in children who have sudden onset of cough and wheezing episode, even when physical and radiographic evidence is absent. Flexible bronchoscopy has become the first choice in China used for FB removal from airways in children.

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