Airway Foreign Bodies In Children Research Articles

Airway Foreign Bodies in Children: A Review Article

Foreign body aspiration (FBA) in children represents a significant morbidity and even mortality producing sudden deaths. Regarded as a major public health issue, FBA may be the end result of aspiration of various organic and inorganic materials. Parental and public awareness including preventive measures is important in avoiding these injuries. The consequences of FBA may pose great challenge for both the children, their families together with clinicians dealing with these children. In this review article it is aimed to discuss the epidemiology, clinical presentations, diagnosis and treatment modalities of FBA in children under the light of relevant literature.

Residual airway foreign bodies in children who underwent rigid bronchoscopy

ObjectiveTo analyze the causes of residual airway foreign bodies in children who underwent rigid bronchoscopy in order to improve the success rate of primary surgery. MethodsClinical data from 1130 children with airway foreign bodies, including 736 males and 394 females aged 0.42–14 years, who underwent rigid bronchoscopy in our hospital from January 2015 to May 2018 were retrospectively collected and analyzed by cluster sampling. Clinical characteristics including sex, age, time of onset, location of the foreign body, type of foreign body and experience of surgeon were gathered. All patients were classified into two groups as Group A (with residual airway foreign bodies) and Group B (without residual airway foreign bodies) according to chest CT scans and fiberoptic bronchoscope examinations after rigid bronchoscopy. The values were compared between the two groups. ResultsThirty-one patients with residual foreign bodies were confirmed by fiberoptic bronchoscopy among 1130 children with airway foreign bodies who underwent rigid bronchoscopy under general anesthesia. The percentage of residual airway foreign body was 2.7%. The mean age was 1.55 ± 0.46 years (range 1–3 years). There were 24 male patients (77.4%), and 7 female patients (22.6%), with a male/female ratio of 3.43:1. The time of onset was 1.0 (interquartile range: 1.0–8.0) day. There were no significant difference in age, sex and time of onset between the two groups. Most residual foreign bodies were food-related: nuts (n = 27, 87.1%), beans (n = 3, 9.7%), and one case was unclear in nature (3.2%). The residual incidence of fragile foreign bodies was higher than non-friable foreign bodies (P = 0.028). The most common residual foreign body locations were left superior lobar bronchi (32.3%), left inferior lobar bronchi (25.8%) and right inferior lobar bronchi (25.8%). The residual rate of foreign bodies for surgeons with more than 5 years of operative experience was 1.92%, and 4.25% for surgeons with less than 5 years of operation experience, showing a significant difference (P = 0.022). ConclusionFriable foods, the complicated structure of the bronchus tree and the surgeon's experience are important causes of residual foreign bodies in the airway. Surgeons with sufficient experience are important for the success of the procedure, which is supported by chest CT and flexible bronchoscopy.

National estimations of airway foreign bodies in children in the United States, 2000 to 2009.

Identify risk factors associated with airway foreign bodies in children in the United States and report observed trends over time. KID database (2000-2009). ICD-9-CM codes for airway foreign bodies were used to identify patients. Risk factors were used for univariate analysis and a multivariate model to identify any increased risk of mortality. These factors were then also trended over time. Children with airway foreign bodies demonstrate similar risk factors as previously reported, such as male gender, age less than five years and lack of private insurance. The weighted mortality rate for paediatric inpatients with airway foreign bodies was about 2.75%. Fortunately, the rate remained relatively unchanged from 2000 to 2009. Geographically, urban hospital settings appeared to be more affected. Increased risks of mortality were noted for older age, urban hospital setting and teaching hospital status. Our findings confirm previous findings and identified that the diagnosis of airway foreign bodies in children were associated with male gender, age <5years, lack of private insurance and geographic location in an urban setting. Further investigation may be warranted to provide clarity on other factors found to have increased association with mortality for quality improvement.

The public health resource utilization impact of airway foreign bodies in children

ObjectiveQuantify the resource utilization associated with airway foreign bodies in children in the United States using a national database and report observed trends over time. Study type: Cross-sectional analysis of national inpatient database with weighted estimates. Data sourceThe KID database (2000–2009). MethodsICD-9-DM codes for foreign body aspiration were used to identify patients to be included for investigation. Admission rates and charges were aggregated and compared among geographic region, location, and teaching hospital status. These factors were then also trended over time. ResultsFrom 2000 to 2009, airway foreign body diagnoses in children accounted for an estimated 4000 to 5000 admissions, resulting in a mean admission rate of 6.6 per 10,000 pediatric patients annually. Charges related to airway foreign bodies in children rose from a total of $93 million to $486 million in the observed period. There is an increasing trend over time of total charges per patient. Charges appear to be higher in urban locations and teaching hospitals. ConclusionsThe public health and economic burden of pediatric airway foreign bodies appears to be rising. Further investigation may be helpful to examine factors that may be contributing to increasing charges and creating strategies to improve cost effectiveness, as well as why there seems to be increased resource utilization in urban locations and teaching hospitals.

The management of complicated airway foreign bodies in children: our institutional experience

The management of complicated airway foreign bodies in children: our institutional experience

25-Year Review of the Abundance and Diversity of Radiopaque Airway Foreign Bodies in Children.

This study was conducted to review the abundance and diversity ofradiopaque foreign bodies over a 25-year period. Overall records of 1,114 patients who underwent rigid bronchoscopy due to foreign body aspiration in the tertiary centres, Imam Khomeini and Apadana; over a 25-year period (1989-2014) were reviewed. History, clinical findings, plain radiography and bronchoscopic findings, foreign body (FB) aspiration (whether radiolucent or radiopaque), time from onset of symptoms until hospitalization, and delay time were all considered. The male/female ratio was 1.53. Most patients were aged 1-3years (53.94%). The most common location of foreign bodies was the right main bronchus (54.57%). The most common type of radiopaque foreign body was meat, chicken and big fish bones (4.84%) followed by metal objects (4.39%). Coughing (70.82%) and cyanosis (22.80%) were the most common symptoms. The most common radiological findings were emphysema (32.31%). Given that the radiological findings are highly specific as regards the detection of radiopaque FB, radiographic examination prior to bronchoscopy for FB localization and shortening the time of bronchoscopy in patients with a history of radiopaque FB aspiration can be helpful. Due to the high morbidity and mortality caused by prolong and repeated bronchoscopy, the use of newer techniques and equipment in shortening extraction time of the foreign bodies should be considered in future researches.

CT evaluation of airway foreign bodies in children: emphasis on the delayed diagnosis and differentiation from airway mucus plugs

To review clinical and CT findings of airway foreign bodies (FBs) among children, with an emphasis on delayed diagnosis and differentiation from mucus plugs (MPs). The CT findings and medical records of 27 patients (M:F = 17:10; mean age, 18.2 months) confirmed for FB (n = 20) and MP (n = 7) were reviewed. These findings were correlated with the bronchoscopic results and clinical outcomes. CT revealed air-trapping (70 %), atelectasis (35 %), pneumonia (25 %), and pneumomediastinum (5 %). Three patients with FB in the carina did not show air-trapping. The densities of the FBs ranged from 17 to 123 Hounsfield units (HU) (n = 17). Eight out of 20 patients (33 %) had a delayed diagnosis of FB. The CT of eight patients revealed air-trapping (n = 2), air-trapping with pneumonia or atelectasis (n = 3), and atelectasis only (n = 1). The airway MPs had a low density (0-5 HU) and were associated with atelectasis (29 %), atelectasis with pneumonia (43 %), and pneumonia (14 %). Air-trapping of the ipsilateral lung may not be a reliable finding among patients with an FB located in the carina and with a small-calibered FB. The absence of air-trapping, the difference in the HU, and the shape of the endobronchial lesion are helpful findings in the differential diagnosis of an MP.

Subglottic Airway Foreign Body

THIS image was obtained during a di-rect laryngoscopy of a 4-yr-old boy. He experienced a choking episode after a witnessed aspiration of a sunflower seed. The seed is lodged at the level of the cricoid. On arrival in the emergency department, the patient was alert with an oxygen saturation of 96%, tachypneic with inspiratory stridor, nasal flaring, subcostal retractions, and accessory muscle use.In the operating room, an induction of midazolam and ketamine was followed by sevoflurane inhalation and maintenance. After an adequate depth of anesthesia was achieved, direct laryngoscopy and rigid bronchoscopy was performed with removal of the sunflower seed. Spontaneous ventilation was maintained throughout the procedure. The child continued to have mild stridor in the postanesthesia care unit, but responded to a single postoperative dose of racemic epinephrine. He was discharged home less than 24 h later.This image indicates how a foreign body can potentially result in complete airway obstruction. The seed traversed the more distensible glottis and lodged at the rigid cricoid ring.1,2The image indicates the potential for complete airway obstruction leading to asphyxia. The subglottic location reinforces two management principles related to airway foreign bodies in children. First, spontaneous ventilation is recommended to prevent the seed from completely obstructing the airway at the level of the cricoid. The second, an observation from the American Heart Association (Dallas, TX), because of the cricoid location of foreign bodies in children, a cricothyrotomy may not relieve complete airway obstruction unless the catheter is passed beyond the foreign body.3In the United States alone, approximately 150 children die each year because of foreign body aspiration.4

Bronchoscopic techniques for removal of foreign bodies in children's airways

The management of airway foreign bodies (AFB) can be a dramatic situation in the emergency treatment of children and different techniques have been used to improve the therapeutic success and minimize risks. to describe the bronchoscopic techniques used in the treatment of AFB in children referred to the Service of Respiratory Endoscopy of HC-FMUSP. Retrospective analysis of 78 children who underwent bronchoscopy for foreign body removal, at our Service from February 2003 to April 2008. 78 patients with an AFB, aged 08 months to 14 years, with 39 being organic and 39 inorganic foreign bodies. Nine foreign bodies were located in the central airway (four in the larynx and five in the trachea), 34 in the right bronchial tree and 33 in the left bronchial tree. There was bilateral aspiration in two cases. All patients were initially submitted to diagnostic flexible bronchoscopy. A rigid bronchoscope was used in 39 cases; a flexible bronchoscope in 23 and an association of techniques in 15 cases (rigid bronchoscopy, flexible bronchoscopy, suspension laryngoscopy, and fluoroscopy). Although the rigid bronchoscopy is considered the main tool for the removal of foreign bodies from airways, other useful techniques deserve attention as part of the medical training. The knowledge and association of different methods in pediatric bronchoscopy add the benefits of one method to another, minimizing the chances of therapeutic failure.

Airway Foreign Bodies in Children

Foreign body aspiration occurs frequently and is a leading cause of pediatric morbidity. At the time of presentation for care, children may be asymptomatic. A high index of suspicion is therefore needed to make the diagnosis. Radiography may aid in establishing the diagnosis but cannot exclude a radiolucent airway foreign body. Bronchoscopy remains the definitive method for diagnosis and the therapy of choice for removal of airway foreign bodies.

Airway foreign body removal by flexible bronchoscopy: experience with 1027 children during 2000–2008

Foreign body aspiration (FBA) into the tracheobronchial tree is a common problem in children necessitating prompt recognition and management. This study aimed to report our experience in airway foreign body removal by flexible bronchoscopy in children. A total of 1027 patients with FBA were reviewed retrospectively. They were 626 boys and 401 girls aged from 5 months to 14 years with a median age of 17 months. The clinical manifestations, radiological findings, bronchoscopic findings and complications of the procedure were analyzed. Among the patients, only 53.4% had a definite history of FBA. The most frequent symptom was paroxysmal cough (84.3%), followed by stridor or wheezing, fever and dyspnea. Chest X-ray showed emphysema in 68.8% of the patients, atelectasis in 13.3% and bronchopneumonia in 56.3%. A bronchoscope was inserted intranasally in most children, but through mouth and endotracheal tube in 17 and 3 children, respectively. Foreign bodies were removed successfully by flexible bronchoscopy with disposable grasping forceps or biopsy forceps in 938 (91.3%) of the patients. The other 89 patients turned to rigid bronchoscopy. During the procedures, 132 (12.9%) of the patients showed transient hypoxia, which was alleviated by oxygen supplement and/or temporary cessation of the procedure. A small amount of bleeding was found in 17 patients and bradycardia in 3. Air leak and laryngeal edema were noted in 2 patients and relieved within 24 hours. Flexible bronchoscopy is useful and safe in retrieving airway foreign bodies in children. With skilled personnel and perfect equipments, flexible bronchoscopy could be considered as the first choice for the removal of airway foreign body.

A Modified Method to Remove Distally Impacted Airway Foreign Bodies in Children

A Modified Method to Remove Distally Impacted Airway Foreign Bodies in Children

A reply to R. West’s comments on Leynes, Marsh, Hicks, Allen, and Mayhorn

Quantify the resource utilization associated with airway foreign bodies in children in the United States using a national database and report observed trends over time. Study type: Cross-sectional analysis of national inpatient database with weighted estimates.The KID database (2000–2009).ICD-9-DM codes for foreign body aspiration were used to identify patients to be included for investigation. Admission rates and charges were aggregated and compared among geographic region, location, and teaching hospital status. These factors were then also trended over time.From 2000 to 2009, airway foreign body diagnoses in children accounted for an estimated 4000 to 5000 admissions, resulting in a mean admission rate of 6.6 per 10,000 pediatric patients annually. Charges related to airway foreign bodies in children rose from a total of $93 million to $486 million in the observed period. There is an increasing trend over time of total charges per patient. Charges appear to be higher in urban locations and teaching hospitals.The public health and economic burden of pediatric airway foreign bodies appears to be rising. Further investigation may be helpful to examine factors that may be contributing to increasing charges and creating strategies to improve cost effectiveness, as well as why there seems to be increased resource utilization in urban locations and teaching hospitals.

Flexible bronchoscopic management of airway foreign bodies in children.

Flexible bronchoscopic management of airway foreign bodies in children.

Flexible Bronchoscopic Management of Airway Foreign Bodies in Children

To evaluate experience with the flexible bronchoscopic management of tracheobronchial foreign bodies (TFBs) in children (age < or = 16 years). All pediatric bronchoscopies performed by the bronchoscopy section at Mayo Clinic Rochester from 1990 through June 2001 for the suspicion of TFBs were reviewed. Information analyzed included the types of bronchoscope (rigid vs flexible) and techniques used, success rates of extraction of TFBs, and complications. Of the 94 children suspected of having TFBs, 39 children (28 boys and 11 girls; mean age, 47.3 months) were found to have 40 TFBs. The flexible bronchoscope was used exclusively to extract TFBs in 24 patients, and in 2 patients in whom the rigid bronchoscopic procedure was unsuccessful. Flexible bronchoscopy was performed through an endotracheal tube in 19 children. In the other five children, the procedure was accomplished through a laryngeal mask airway (LMA). In two additional patients in whom the rigid bronchoscopic procedure was unsuccessful, the instrument served as a conduit for the passage of the flexible bronchoscope. The extraction instruments employed included ureteral stone baskets and stone forceps. Since 1994, all extractions of TFBs were successfully accomplished with the flexible bronchoscope. Complications occurred in four patients who underwent rigid bronchoscopy, and included postbronchoscopy laryngeal edema manifested by stridor, cough, and respiratory distress. These resolved quickly with medical therapy. Flexible bronchoscopic extraction of pediatric TFBs can be performed safely with minimal risks and complications. In our experience, it was successful in all children in whom it was employed. Nevertheless, we caution that provisions be made to provide immediate rigid bronchoscopic management, should the attempts at flexible bronchoscopic extraction fail.

The choking child: What happens before the ambulance arrives?

Objective. To compare pre-EMS intervention (bystander intervention) with EMS intervention (performed by fire department/EMS personnel) in the management of airway foreign bodies in children. Methods. First-responding paramedic run reports for 1994 in the metropolitan area (city and county fire departments) pertaining to acute foreign body airway obstruction in children (aged 0–15 years) were reviewed. Data regarding age, gender, type of foreign body, method by which the airway was cleared, and mode of transportation were extracted. Results. There were 103 runs with an age distribution as follows: 0–11 months 39.8%; 1–5 years 50.5%; and >6 years 9.7%. Fifty-eight (56.3%) involved males and 45 (43.7%) involved females. Eighty-five percent of the airways were cleared before EMS arrival. Thirty-eight percent were self-cleared by the child. The chance of airway clearance before EMS arrival increased with increasing age: 78% of the children aged 0–11 months, 88.5% of the children 1–5 years of age, and 100% of the children aged 6 years or older had their airways cleared before EMS arrival. Forty-four percent of the children were not transported, and 27% were transported by private vehicle. Coins and food were the two most common foreign bodies. Conclusion. The majority of airway foreign bodies were cleared before EMS arrival, especially in older children. This supports CPR training of new parents and the general population and has training implications for the EMS provider in managing the pediatric airway.

Foreign body aspiration in children: Value of radiography and complications of bronchoscopy

Purpose: The authors undertook a 10-year review of bronchoscopies for airway foreign bodies in children to test assertions in previous reports that (1) characteristic abnormalities in chest radiographs are important indicators of the need for bronchoscopy and (2) experienced operators incur negligible complications. Methods: The medical records of 293 children who under-went bronchoscopies by experienced pediatric surgeons for suspected airway foreign bodies were reviewed for patient age, symptoms, duration of symptoms before bronchoscopy, prebronchoscopy radiographs, type of foreign body, anatomic location of foreign body, success of bronchoscopic removal, length of hospital stay, and complications. Results: Of the 293 bronchoscopies, 265 showed airway foreign bodies. A choking episode was recorded in 228 of the 265 patients with foreign bodies and 5 of the 28 with negative bronchoscopy. The surgeon thought that radiographs were normal at the time of bronchoscopy in 110 patients who had foreign bodies. Nine patients with foreign bodies had atypical radiographs; three had bilateral emphysema and six had upper lobe or bilateral atelectasis or pneumonia. There were three complications: one vocal cord injury requiring temporary tracheostomy, one tracheal laceration from removal of an aspirated tooth, and one severe postoperative subglottic edema requiring a 4-day hospital stay. The age of the patients, symptoms, types of foreign bodies, locations of foreign bodies, management, and outcomes were similar to those of previous reports. Conclusions: In children with airway foreign bodies, chest radiograph findings are frequently normal and can display abnormalities uncharacteristic for foreign body aspiration. Children witnessed to choke while having small particles in their mouths and noted subsequently to have raspy respiration, wheezing, or coughing should undergo prompt bronchoscopy regardless of radiographic findings. Complications of bronchoscopy for foreign body aspiration are uncommon but occur even in experienced hands.

Simple x-ray findings of airway foreign bodies in children

Simple x-ray findings of airway foreign bodies in children