Management and prevention of foreign body aspiration in children

Abstract

Objective To put forward the prevention advice on foreign body suction, and to discuss the efficacy, safety and application experience of flexible bronchoscopy in the diagnosis and treatment of tracheobronchial foreign bodies in children. Methods The treatment experience of 38 cases for airway foreign body removal with flexible bronchoscopy and granulation tissue proliferation in Argon plasma coagulation(APC)(argon knife) combining carbon dioxide(CO2) cryotherapy in Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command from January 2013 to December 2014 were reviewed, and the clinical data including age, gender, treatment time for inhaled foreign body, clinical and X-ray manifestations, location of the foreign body, treatment with bronchoscopy with APC and cryotherapy, complications and outcomes were analyzed. Results There were 38 cases of patients including 31 male(81.6%) and 7 female(18.4%), aged from 10 months to 14 years old, with mean age 28.5 months; among them there were 30 cases with definite history of foreign body, accounting for 78.9%; the most common clinical symptom was cough among the cases, accounting for 84.3%; X ray showed 15 cases with ipsilateral lung atelectasis, accounting for 39.5%, emphysema in 17 cases, accounting for 44.7%, pneumonia change in 6 cases, accounting for 15.8%, there were 11 cases who had lung computerized tomography examination when coming to the hospital, and only 1 case could be seen to have foreign body shadow; microscopic examination found that inhaled foreign body in the right bronchus accounted for 57.9%, and peanut was the main foreign body inhalation in this group; only 4 cases(10.5%) had definite diagnosis and foreign body removal within 24 h after foreign body aspiration, moreover, 34 cases(89.5%) with foreign body aspiration got the diagnosis and treatment after 24 h; crying was the primary inducement for inhaled foreign body.All the 38 cases of children with inhaled foreign body experienced removal under flexible bronchoscopy.There were 19 cases(50.0%) who had granulation tissue proliferation around the foreign body, among which 5 cases of foreign body was wrapped by the proliferation of granulation tissue, with APC dealing with the granulation tissue of foreign body surface to remove foreign body after exposure, then giving CO2 cryotherapy.Nevertheless, there were 9 cases of foreign body who had granulation tissue but was not wrapped, receiving CO2 cryotherapy directly after the foreign body removal.One case of this group had bradycardia during the surgery, and 2 cases had postoperative bleeding, but there was no death cases with foreign bodies removal. Conclusions Education is the key to prevent foreign body aspiration in infants under 3 years old.Flexible bronchoscopy is safe to remove foreign bodies from the respiratory tract and has fewer complications, so it is one of the alternative methods in diagnosis and treatment of foreign body inhalation. Key words: Flexible bronchoscopy; Tracheobronchial foreign body; Argon plasma coagulation; Freezing techniques; Granulation tissue; Child