Airway Foreign Body Aspiration

2018 ◽  
Author(s):  
Sarah Nizamuddin ◽  
Caitlin Aveyard
Keyword(s):  
Foreign Body ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Definitive Diagnosis ◽  
Supraglottic Airway ◽  
Intravenous Anesthesia ◽  
Good Communication ◽  
Controlled Ventilation ◽  
Life Threatening ◽  
Volatile Agents

Aspiration of a foreign body is a potentially life-threatening problem that often necessitates an anesthetic for removal of the foreign body. Foreign body aspiration is most common among children aged 1 to 4 years old and has a wide variety of symptoms ranging from a mild, nagging cough to complete airway obstruction. Definitive diagnosis and treatment of foreign body aspiration involve flexible or rigid bronchoscopy. The urgency of the procedure depends on the type of object aspirated and the location of the foreign body in the airway. The appropriate anesthetic for removal of the foreign body is dependent upon the surgeon’s plan and involves several steps in decision-making: intravenous versus inhalational induction, airway maintenance (endotracheal tube vs. supraglottic airway vs. mask), spontaneous versus controlled ventilation, maintenance of anesthesia (total intravenous anesthesia vs. volatile agents). Good communication with the surgeon or proceduralist is key to a safe and effective anesthetic.

scholarly journals Urgent bronchoscopy for foreign body aspiration: 48 children among 1096 patients

Acta Medica ◽  
2019 ◽  
Vol 50 (3) ◽  
pp. 38-43
Author(s):  
Alper Avcı ◽  
Onder Ozden ◽  
Zehra Hatipoglu ◽  
Serdar Onat
Keyword(s):  
Foreign Body ◽  
Postoperative Complications ◽  
Oxygen Saturation ◽  
English Literature ◽  
Length Of Hospital Stay ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Peripheral Oxygen Saturation ◽  
Life Saving ◽  
Life Threatening

Objective: Foreign body aspiration (FBA) is a potentially life-threatening emergency in children. Urgent rigid bronchoscopy (URB) should be performed when presentation includes severe respiratory failure with suspicion for FBA. To the best of the knowledge, this is the first study that evaluates URB in English literature. Methods: Forty-eight patients who underwent URB were included in this study. From the medical records, the patients’ demographic characters, endotracheal intubation status, peripheral oxygen saturation, bronchoscopy results, type and location of foreign body (FB), intra- and postoperative complications and mortality, X-ray, length of hospital stay were evaluated. Results: Twenty-four of the 48 patients were non-intubated. Peripheral oxygen saturation values were 60 ± 14.40 in the preoperative period. No statistical differences were found between intubated and non-intubated patients in terms of intra- and postoperative complications. There were no statistical differences between patients with negative and positive results for bronchoscopy in terms of intra- and postoperative complications. Conclusions: Bronchoscopy is not without risk; however, it is a life-saving procedure. Despite negative FB results, urgent bronchoscopy should be performed in suspicious cases.

Reducing the number of rigid bronchoscopies performed in suspected foreign body aspiration cases via the use of chest computed tomography: is it safe? A literature review

2014 ◽  
Vol 129 (S1) ◽  
pp. S1-S7 ◽  
Author(s):  
P Tuckett ◽  
A Cervin
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Gold Standard ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Review Of Literature ◽  
Chest Computed Tomography ◽  
Non Invasive ◽  
Life Threatening ◽  
Sensitivity Specificity

AbstractBackground:Foreign body aspiration is common and potentially life threatening. Although rigid bronchoscopy has the potential for serious complications, it is the ‘gold standard’ of diagnosis. It is used frequently in light of the inaccuracy of clinical examination and chest radiography. Computed tomography is proposed as a non-invasive alternative to rigid bronchoscopy.Objective:This study aimed to evaluate the accuracy and safety of computed tomography used in the diagnosis of suspected foreign body aspiration, and compare this with the current gold standard, in order to examine the possibility of using computed tomography to reduce the number of diagnostic rigid bronchoscopies performed.Method:The study comprised a review of literature published from 1970 to 2013, using the PubMed, Scopus, Web of Knowledge, Embase and Medline electronic databases.Results:The sensitivity for computed tomography ranged between 90 and 100 per cent, with four studies demonstrating 100 per cent sensitivity. Specificity was between 75 and 100 per cent. Radiation exposure doses averaged 2.16 mSv.Conclusion:Computed tomography is a sensitive and specific modality in the diagnosis of foreign body aspiration, and its future use will reduce the number of unnecessary rigid bronchoscopies.

scholarly journals Left Bronchial Foreign Body Is Always Left Rigid Bronchoscopy an Armour Beyond Barriers in Retrieval-A Case Series

2020 ◽  
Vol 5 (3) ◽  
Keyword(s):  
Foreign Body ◽  
Food Item ◽  
Foreign Bodies ◽  
Case Series ◽  
Clinical Situation ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Bronchial Foreign Body ◽  
Life Threatening ◽  
Airway Foreign Body

Airway foreign bodies (AFBs) is an interdisciplinary area between, Pediatrics and Otolaryngology [1]. Foreign-body aspiration in the airway of children is a life-threatening clinical situation responsible for many deaths each year. Most airway foreign body aspirations occur in children younger than 15 years; children aged 1-3 years are the most susceptible [2]. Vegetable matter tends to be the most common airway foreign body; peanuts are the most common food item aspirated [5]. We present four interesting cases of bronchial foreign bodies that caused diagnostic and therapeutic challenges.

scholarly journals A comparison between Sevoflurane Volatile Induction/Maintenance Anesthesia and Propofol Total Intra-venous Anesthesia for Rigid Bronchoscopy under Spontaneous Breathing for Tracheal/Bronchial Foreign Body Removal in Children

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
O M T Al-Safty ◽  
O R Youssef ◽  
D M Kamaleldin ◽  
M K M Youssef
Keyword(s):  
Foreign Body ◽  
Controlled Trial ◽  
Anesthetic Management ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
Foreign Body Removal ◽  
Bronchial Foreign Body ◽  
Threatening Condition ◽  
Life Threatening ◽  
Double Blinded

Abstract Background Foreign body aspiration is a life-threatening condition. Asphyxiation from inhaled foreign bodies is a leading cause of accidental death among children younger than 4 years. While early clinicians used topical anesthesia, general anesthesia became common place for the removal of aspirated objects with increased experience with the rigid bronchoscope and advances in anesthetic delivery. Inhaled anesthesia and total intravenous anesthesia are widely used for rigid bronchoscopy in children. Objective In this study, we compared sevoflurane VIMA and propofol TIVA, when used for both induction and maintenance of anesthesia in children undergoing rigid bronchoscopy for tracheal or bronchial foreign body removal. Methods This is a prospective double – blinded, randomized controlled Trial, After Approval is obtained from the research ethics committee of anaesthesia and intensive care department, Ain Shams University. Patients were randomly divided into two groups (n = 30 each). In Group VIMA, anesthesia was induced with inhalation of sevoflurane. Before induction, a closed circuit with a 1-l reservoir bag was overflowed by 8 vol % sevoflurane with 0.3 l/min fresh oxygen flow for 3 min. In Group TIVA, a bolus of 2.5 mg/kg propofol was administered over 30 seconds. Additional propofol 0.5–1 mg/kg was given as needed to deepen anesthesia. Results Our results demonstrate that compared with propofol TIVA, sevoflurane VIMA provides more stable haemo-dynamics and respiration, faster induction and recovery and higher incidence of excitement in paediatric patients undergoing tracheal/bronchial foreign body removal. Conclusion Foreign body aspiration is a life-threatening condition. Anesthetic management can be challenging, as the airway is shared with the surgeon and adequate ventilation must be maintained despite airway manipulation.

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

BMC Surgery ◽  
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.

scholarly journals Foreign Body Aspiration in Dentistry

2021 ◽  
pp. 8-14
Author(s):  
Drishti Dixit ◽  
Amit Reche ◽  
Kumar Gaurav Chabra ◽  
Priyanka Paul Madhu ◽  
Anura Saher Raza
Keyword(s):  
Foreign Body ◽  
Standard Operating Procedure ◽  
Foreign Body Aspiration ◽  
Careful Study ◽  
Age Group ◽  
Aged Patients ◽  
Age Related ◽  
Threatening Condition ◽  
Foreign Body Extraction ◽  
Life Threatening

Background: The foreign body aspiration is very common while performing a dental procedure. Most of the patients are from lower age group as these group of people have high amount of sugar and starch containing diet which is not good for the oral health. But it is not limited to them and several aged patients are also victim of foreign body aspiration. Summary: Foreign bodies can be anything from cloth dam, barrier techniques itself to broken tooth. Due to age related delayed gag reflex and impact of anesthesia can be possible reasons behind the foreign body aspiration. Pulmonary aspiration is a serious cause of concern and cannot be neglected. It can go unnoticed which can brought to cognizance after careful study and observation of the radiographs. Endoscopic procedures are used to locate and extract the foreign body from the lungs. Conclusion: Proper guidelines regarding the extraction of foreign body extraction and identification must be followed as it is life threatening condition. Vulnerable age group must be treated with extra caution and every chance of mistake must be covered. Standard operating procedure must be strictly adhered to in order rot have maximum accuracy.

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

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>

scholarly journals A gyermekkori alsó légúti idegentest-aspiráció diagnosztikája a klinikai gyakorlatban

2018 ◽  
Vol 159 (51) ◽  
pp. 2162-2166
Author(s):  
Dániel Hajnal ◽  
Tamás Kovács
Keyword(s):  
Foreign Body ◽  
Standard Procedure ◽  
False Negative ◽  
Radiological Finding ◽  
Paediatric Population ◽  
Rigid Bronchoscopy ◽  
Foreign Body Aspiration ◽  
X Ray ◽  
Co Morbidity ◽  
Chest X Ray

Abstract: Introduction and aim: Rigid bronchoscopic foreign body removal is the gold standard procedure for foreign body aspiration. We have analysed our results of bronchoscopies and the accuracy of diagnosis among the paediatric population in Southeast Hungary. Method: A retrospective study of children admitted because of suspected solid foreign body aspiration between 2006 and 2017 was performed. Results: From among 220 admitted patients, 86 were suspected of solid particle aspiration. Presenting history was certain in 68.6% (n = 59/86). Sudden choking-like symptoms were present in 61/86 patients (70.9%), coughing in 81/86 patients (94.2%). Thoracic auscultation was positive in 67/86 cases (77.9%), chest X-ray in 75/86 patients (87.2%), while fluoroscopy only in 12/75 cases (16%). 92 bronchoscopies in 86 patients were performed. In 57 bronchoscopies, solid foreign body was found (66.2%) and the removal was successful in 56 cases. Thoracic auscultation was negative in patients with foreign body only in 6/57 cases (10.5%). In the same group, chest X-ray was negative in 33/57 cases (57.9%) and fluoroscopy was positive only in 12/57 patients (21.1%). Pneumonia or prolonged bronchitis was present in 4/86 patients (4.6%). Severe bronchial bleeding occurred in 2/86 cases (2.3%). Mortality was 1.2%, a child with severe co-morbidity and chronic aspiration passed away. Bronchoscopy was negative in 29/86 patients (33.7%). Complications were significantly higher in chronic cases than in the acute ones. Conclusion: Rigid bronchoscopy is indicated if solid foreign body aspiration is suspected and positive anamnesis, typical symptoms (coughing, choking) or positive chest auscultations are present. Diagnosis predominantly based on radiological finding is controversial due to the high possibility of false negative results. Early intervention within the first 24 hours is recommended to avoid complications. Orv Hetil. 2018; 159(51): 2162–2166.

scholarly journals Application of the Virtual Bronchoscopy in Children with Suspected Aspiration of the Foreign Body - Case Report

2016 ◽  
Vol 17 (4) ◽  
pp. 361
Author(s):  
Gordana Kostic ◽  
Marina Petrovic ◽  
Slavica Markovic ◽  
Jasmina Knezevic ◽  
Zoran Igrutinovic ◽  
...  
Keyword(s):  
Foreign Body ◽  
Fiber Optic ◽  
Inhaled Corticosteroids ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Rigid Bronchoscopy ◽  
Virtual Bronchoscopy ◽  
Peripheral Airways ◽  
Life Threatening ◽  
Body Case

Abstract In diagnosing the aspiration of the foreign body (AFB) in children most important are: medical history, clinical signs and positive radiography of the lungs. Common dilemmas in the diff erential diagnosis are life-threatening asthma attacks or difficult pneumonia. Conventional rigid bronchoscopy (RB) is not recommended as a routine method. Virtual bronchoscopy (VB) can be a diagnostic tool for solving dilemmas. Fiber-optic bronchoscopy (FOB) has a therapeutic stake in severe cases. Herein, we describe a girl, at the age of 6, who was hospitalized due to rapid bronchoconstriction and based on the anamnesis, clinical symptoms and physical fi ndings the suspicion was that she aspirated the foreign body. Due to the poor general condition and possible sequel, the idea of RB was dropped out. Multidetector computed tomography of the chest and VB was performed and AFB was not found. Due to positive epidemiological situation, virus H1N1 was excluded. FOB established that the foreign body does not exist in the airways. During bronchoscopy numerous castings are aspirated from the peripheral airways which lead to faster final recovery. With additional procedures, the diagnosis of asthma was confirmed and for girl that was the first attack. Along with inhaled corticosteroids as prevention she feels well. Virtual bronchoscopy can be successfully used as a valid diagnostic procedure in suspected foreign body in the children’s lungs, but fiber-optic bronchoscopy remains most important diagnostic and therapeutic method.

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