Application of Rigid Bronchoscopy for Emergent Removal of Tracheobronchial Foreign Body in Paediatric Cases: A Learning Curve Study

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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A Case of Whistle as Foreign Body in Trachea

BioScientia Medicina ◽

10.32539/bsm.v6i1.434 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1281-1286

Author(s):

Puspa Zuleika

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Pediatric Patients ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Foreign Object ◽

Case Presentation ◽

Foreign Body Extraction ◽

Tracheobronchial Foreign Body ◽

History Of

Background. Most of foreign body aspiration cases are found in children under the age of fifteen. Pediatric patients often presents with non-food foreign body aspiration, such as toys. The most common clinical manifestation are history of choking following foreign object insertion into the mouth (85%), paroxysmal cough (59%), wheezing (57%) and airway obstruction (5%). Case presentation. Main principle of airway foreign body extraction is to do it immediately in the most optimal condition with slightest possible trauma. Rigid bronchoscopy is a suitable choice for tracheal foreign body extraction. We reported a case of seven years old male with tracheal foreign body presented with history of whistle ingestion five hours prior to admission. This patient was discharged from hospital after third days of rigid bronchoscopy procedure. Conclusion. History of foreign body aspiration in children should be suspected as a tracheobronchial foreign body. Rigid bronchoscopy is preferred to extract foreign bodies present in the trachea. The prognosis for tracheobronchial foreign body aspiration is good if the foreign body is treated early and without complications.

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Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal

Pediatric Anesthesia ◽

10.1111/j.1460-9592.2005.01714.x ◽

2006 ◽

Vol 16 (2) ◽

pp. 123-129 ◽

Cited By ~ 50

Author(s):

MAREN TOMASKE ◽

ANDREAS C. GERBER ◽

MARKUS WEISS

Keyword(s):

Foreign Body ◽

Rigid Bronchoscopy ◽

Tracheobronchial Foreign Body

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Tracheobronchial foreign body aspiration: A 13-year retrospective analysis

Medicinski pregled ◽

10.2298/mpns14s1069d ◽

2014 ◽

Vol 67 (suppl. 1) ◽

pp. 69-74

Author(s):

Danijela Dragicevic ◽

Ljiljana Jovancevic ◽

Rajko Jovic ◽

Ljiljana Vlaski ◽

Bojan Bozic

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Main Bronchus ◽

Age Groups ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Radiological Findings ◽

Tracheobronchial Foreign Body ◽

The Moment ◽

The Right

Introduction. Foreign body aspiration into the respiratory tract remains a diagnostic and therapeutic challenge in clinical practice, especially in young children, who are the most frequently affected age group. The aim of this study was to present the results of treating the patients with foreign body aspiration in all age groups. Material and Methods. The medical and radiological records of 64 patients with confirmed foreign body out of 146 patients with suspected foreign body aspiration were retrospectively analyzed during the period of 13 years (from 2001 to 2013). Results. A foreign body was found in 64 (44%) of the 146 patients of all age groups with suspected foreign body aspiration. The patients? age ranged between 11 months and 80 years. There were 84% children and 16% adults, and 63% of patients were male. Time between the moment of aspiration and admission to the Department ranged between 0.5 hours and 14 days, with majority of patients (70%) being admitted during the first 24 hour. History of respiratory drama was present in 92% of patients. Physical and radiological findings were positive in 66% and 47% of patients, rescpectively. Organic vegetable foreign bodies accounted for 75% of all cases, and they were most frequently found in the right main bronchus (63%). All foreign bodies were successfully extracted by rigid bronchoscopy, without serious complications and fatal outcomes. Conclusion. Bronchoscopy should be performed in any case of suspected foreign body aspiration, even if clinical and radiological findings are normal, in order to avoid serious and possible life-threatening complications. More should be done to raise awareness of this potentially preventable condition.

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Anesthesia during rigid bronchoscopy for tracheobronchial foreign body removal in children：A Systematic Review and Meta-analysis of Comparative Studies

10.22541/au.161018903.39398423/v1 ◽

2021 ◽

Author(s):

Weiping wang ◽

Shangyingying Li ◽

Hui Liu ◽

Qin Tian ◽

Hang Chen ◽

...

Keyword(s):

Foreign Body ◽

Meta Analysis ◽

Body Movement ◽

Rigid Bronchoscopy ◽

Total Intravenous Anesthesia ◽

Intravenous Anesthesia ◽

Foreign Body Removal ◽

Volatile Anesthesia ◽

Tracheobronchial Foreign Body ◽

Ventilation Modes

Background: There is no consensus regarding the optimal anesthetic approach to rigid bronchoscopy in children suffering from tracheobronchial FBA. We performed this meta-analysis to assess the efficacy and safety of the different anesthesia agents and ventilation modes for tracheobronchial foreign body removal via rigid bronchoscopy in young children. Methods: A systematic search of three major databases for all relevant articles. A meta-analysis was performed to analyze the data. Results: Four trials for evaluating different anesthetics and six trials for evaluating two kinds of ventilation modes were found. Compared with the sevoflurane-based volatile anesthesia group , the rate of perioperative complications included hypoxemia (OR, 2.07; 95% CI, 1.38–3.11; P=0.0004; I2 = 0%), apnea (OR, 2.74; 95% CI, 1.11–6.78; P = 0.03; I2 = 60%), laryngospasm (OR, 2.89; 95% CI, 1.67–4.98; P=0.0001; I2 = 0%), cough/bucking (OR, 2.93; 95% CI, 1.86–4.63; P<0.00001; I2 = 0%), and body movement (OR, 3.51; 95% CI, 2.03–6.09; P<0.00001; I2 = 0%) were significantly increased in the propofol-based total intravenous anesthesia and the duration of operation were longer in the Group Prop. Compared with the control ventilation group , the incidences of laryngospasm (OR, 0.16; 95% CI, 0.05–0.56; P=0.004; I2 = 54%), apnea (OR, 0.21; 95% CI, 0.09–0.50; P=0.0004; I2 = 0%), and cough/bucking (OR, 0.03; 95% CI, 0.01–0.10; P<0.00001; I2 = 41%) increased in the spontaneous ventilation group and the duration of operationand emergence from anesthesia significantly prolonged in the Group SV. Conclusions: Our meta-analysis suggests that sevoflurane-based volatile anesthesia was superior to propofol-based total intravenous anesthesia for the management of foreign body aspiration in children. There is still no strong evidence indicated that one ventilation technique was superio

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Clinico-radiological predictors of positive rigid bronchoscopy findings in children with suspected tracheobronchial foreign body aspiration

Australian Journal of Otolaryngology ◽

10.21037/ajo.2018.01.07 ◽

2018 ◽

Vol 1 ◽

pp. 11-11 ◽

Cited By ~ 1

Author(s):

Matthew M. Kwok ◽

Aaron Wong ◽

Paul Paddle ◽

Stacy Goergen ◽

Joanne Rimmer

Keyword(s):

Foreign Body ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Tracheobronchial Foreign Body

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ROLE OF RIGID BRONCHOSCOPY IN MANAGEMENT OF TRACHEOBRONCHIAL FOREIGN BODY ASPIRATION

Journal of Medical Sciences ◽

10.52764/jms.20.28.4.8 ◽

2020 ◽

Vol 28 (4) ◽

pp. 345-347

Author(s):

Israr ud Din ◽

Muhammad Hafeez ◽

Muhammad Junaid ◽

Arif Raza Khan ◽

Imran Khan

Keyword(s):

Foreign Body ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Foreign Body Bronchus ◽

Number Of Patients ◽

Tracheobronchial Foreign Body ◽

History Of ◽

Male Patients ◽

One Year

Objective: To determine the role of Rigid Bronchoscopy in Management of Tracheobronchial Foreign Body Aspiration. Material and Methods: This study was conducted in otolaryngology department, Khyber teaching hospital, Peshawar of one year duration from January 2018 to December 2019. Total 90 Patients of age 4 months to 14 years on clinical suspicion of foreign body bronchus were included, while patients with history of bronchial asthma, pulmonary tuberculosis and radio opaque foreign body bronchus were excluded. Results: Total number of patients was 90 in which male patients were 60 (66.67 %) and female patients were 30 (33.33 %), patients with foreign body bronchus were 80 (88.89%). Male patients with foreign body bronchus was 53 (58.89%) and female 27 (30.00%). In age range from 4 months to 3 years, 35(39%) Patients underwent bronchoscopy in which foreign body bronchus retrieved in 30(37.5%) patients. Conclusion: Patients with history of repeated chest infection, relieved by medicines for some time should not be over look, as vegetative foreign body bronchus are radiolucent and patients usually present late in respiratory compromised state, the clinician must urge, for prompt treatment as rigid bronchoscopy.

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Tracheobronchial Foreign Body Aspiration: Dental Prosthesis

Case Reports in Pulmonology ◽

10.1155/2014/465856 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Ataman Köse ◽

Dilek Kostak ◽

Erol Aramagan ◽

Aslıhan Durak ◽

Nur Sezin Seçkin ◽

...

Keyword(s):

Foreign Body ◽

Signs And Symptoms ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Dental Prosthesis ◽

Tracheobronchial Foreign Body ◽

Bronchial System ◽

Foreign Materials ◽

Dental Apparatus ◽

The Right

It is important to extract foreign bodies for avoiding life-threatening complications. They can lead to death if they are not treated. Different signs and symptoms could occur according to the complete or partial airway obstruction. Foreign body aspiration is a rare incident in adults. The organic foreign materials such as foods are found to be aspirated more commonly and are usually settled in the right bronchial system. However, dental prosthesis and teeth aspirations are rare in literature. In our study, a 52-year-old male patient who had aspirated the front part of his lower dental prosthesis accidentally is presented and the foreign body is extracted by using rigid bronchoscopy. There are many causes of aspiration but dental prosthetic aspirations should be kept in mind during sleep. For this reason, dental apparatus must be taken out while asleep.

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