Airway Foreign Body Aspiration Research Articles

Pathologies of the larynx and trachea in childhood.

Pathologies in the larynx and trachea in the pediatric age can be characterized in 4 main groups: airway stenosis, acute infections, benign neoplasia and foreign body aspiration. In this review main diagnostic strategies and therapeutic options are presented.Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it’s repair using an endoscopic approach.Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred.Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases.Tracheostomy is not a safe airway in early infancy, it’s indication should be strict.Foreign body aspiration needs to be managed according to a clear algorhythm.Recurrent respiratory papillomatosis should be treated with emphasis on function preservation. The role of adjuvant medication remains unclear.Infectious diseases can be managed conservatively by a pediatrician in the majority of cases.

Cayenne aspiration: an unusual type of lower airway foreign-body aspiration.

PurposeCayenne aspiration is an unusual type of foreign-body aspiration that is usually misdiagnosed. This article analyzes the clinical features of cayenne aspiration in the lower airway.Patients and methodsClinical data on eight adult patients with cayenne aspiration were retrospectively analyzed. Six were elderly patients. The data were collected from Peking University First Hospital and Anhui Chest Hospital between January 2010 and August 2014.ResultsThe most common symptoms of cayenne aspiration were cough (eight cases, 100%) and sputum (five cases, 62.5%). Only one patient (12.5%) could supply the history of aspiration on his first visit to doctor and was diagnosed definitely without delay. The other seven cases were misdiagnosed as pneumonia and the time to accurate diagnosis was from 1 month to 6 months. The history of aspiration could be recalled after confirmed diagnosis for the other seven cases. The most common presentation shown by chest computed tomography (CT) was pneumonic opacity (eight cases, 100%). The existence of cayenne could not be detected by chest CT in any of the patients. All the patients were diagnosed definitively and managed successfully with flexible bronchoscopy. Cayenne was more often lodged in the right bronchus tree (seven cases, 87.5%), especially the right lower bronchus (four cases, 50%). The segment of cayenne was complete in five cases (62.5%) and scattered in three cases (37.5%).ConclusionThe clinical features of cayenne aspiration are usually obscure and nonspecific which may lead to delay in diagnosis. Flexible bronchoscopy is safe and useful for early diagnosis and effective management.

Survey of foreign body aspiration in airways and lungs.

Introduction:Foreign body aspiration is a very serious problem and the diversity of clinical protests in each geographic region has its own characteristics and common problems of childhood that is an important cause of mortality and morbidity. No area is separate from this problem and conducting this research is due to achieve basic information regarding foreign body aspiration.Materials and Methods:This was performed as descriptive - cross sectional study on 200 cases that has been hospitalized in Imam Khomeini Hospital, Urmia due to foreign body aspiration problem from 2009 to 2011. And all cases of foreign body aspiration records extracted and analyzed using SPSS 16 software.Results:Foreign body aspiration under 4 years was 57% and was more common in males than females; approximately 74% of patients were hospitalized in the first 10 days and 13% of patients did not remember the initial incident that led to the aspiration. Cough and shortness of breath and reduced lung sounds and wheezing were common symptoms. Chest radiographic findings are not specific and can be normal of a high percentage. The most common aspirated foreign body was food especially sunflower seeds. Right bronchus with 55% of cases was more common than the left bronchus and all patients were treated with rigid bronchoscopy, 24% of patients had complications, 15% had hospitalized with pneumonia. Totally, 75% of patients were urban residents.Discussion:We need to understand all the aspects related to foreign body aspiration and education to the community, to recognize symptoms and type of foreign body in terms of geographical area and to create a strong clinical suspicion in physicians and awareness of its prevalence that by reducing the incidence and early detecting and treatment can reduce the mortality and morbidity and prevent additional expenses.

Increased T cell activation in BALF from children with Mycoplasma pneumoniae pneumonia.

The mechanisms of Mycoplasma pneumoniae induced lung inflammation are not clearly understood yet. This study investigated whether activated T cells in the airway contributed to the pulmonary inflammation in patients with severe Mycoplasma pneumoniae pneumonia (MPP). BALF were collected in all 45 patients with MPP (MPP, n = 45), including mild (Mild, n = 20) and severe (Severe, n = 25) group. BALF in 20 of all 25 severe cases with MPP at the recovery stage (Rec-severe, n = 20) were collected again. The control group consisted of 20 patients with airway foreign body aspiration (Con., n = 20). CD3+ T cells, CD69+, HLA-DR+, CD25+ on CD3+ T cells in BALF were determined by flow cytometry. Levels of IL-6, IL-10 in BALF were determined by ELISA, and percentage of neutrophils was counted. A significant increased percentage of neutrophils and levels of IL-6 and IL-10, decreased percentage of CD3+ T cells, increased expressions of CD69+, HLA-DR+ or CD25+ on CD3+ T cells were observed in children with MPP compared with the control group (P < 0.05 or 0.01). Compared to mild group, the percentage of neutrophils, CD3+ CD25+, IL-6, and IL-10 were increased in children with severe MPP (P < 0.01 or 0.05). Compared to acute stage, an increased percentage of CD3+ T cells, decreased percentage of neutrophils and IL-6 level, and expressions of CD3+ CD69+ or CD3+ CD25+ were observed at the recovery stage in children with severe MPP (P < 0.01 or 0.05). Increased activation of T cell in BALF may play an important role in the inflammatory response of acute and severe MPP. IL-6 may predict the severity and prognosis and provide a better assessment for patient care. However, the underlying mechanism awaits further detailed investigations.

Erkrankungen von Larynx und Trachea im Kindesalter

Pathologies in the larynx and trachea in the pediatric age can be characterized in 4 main groups: airway stenosis, acute infections, benign neoplasia and foreign body aspiration. In this review main diagnostic strategies and therapeutic options are presented. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach. Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred. Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Tracheostomy is not a safe airway in early infancy, it's indication should be strict. Foreign body aspiration needs to be managed according to a clear algorhythm. Recurrent respiratory papillomatosis should be treated with emphasis on function preservation. The role of adjuvant medication remains unclear. Infectious diseases can be managed conservatively by a pediatrician in the majority of cases.

An alternative method of management of pediatric airway foreign bodies in the absence of rigid bronchoscopy

ObjectivePediatric airway foreign body aspiration is a life-threatening clinical entity. The standard of care for managing this situation is endoscopic retrieval using rigid bronchoscopy. However in resource-limited settings rigid bronchoscopy may not be available. This retrospective case series describes the successful application of one treatment modality for pediatric airway foreign body. MethodsA retrospective review was performed for seven pediatric patients who were treated at Soddo Christian Hospital with a diagnosis of airway foreign body aspiration. All patients were treated in the operating room using general anesthesia, a combination of inhaled halothane and intravenous ketamine. Paralytics were not used in any patient and spontaneous breathing was maintained. Flexible fiberoptic bronchoscopy was initially performed on each patient to confirm the presence of a foreign body and identify the anatomic position with the airway. Using a standard technique, a tracheotomy was performed. If the foreign body was still noted to be distal to the tracheotomy, postural percussion was performed to dislodge the foreign body into the trachea. Once the foreign body was identified at the tracheotomy, it was removed. ResultsAll seven patients presented in respiratory distress and were emergently managed in the operating room. The average age was 2.8 years (6 months–8 years of age). The foreign bodies were successfully removed in all patients. There were no mortalities and all patients were successfully discharged from the hospital. ConclusionsPediatric airway foreign body aspiration is a life-threatening clinical entity in any setting, but it presents unique challenges in resource-limited settings where rigid bronchoscopy is not available. This report presents one such treatment modality and utilizes a combination of flexible fiberoptic bronchoscopy and tracheotomy to treat such patients.

Diagnosis and treatment of tracheobronchial foreign bodies in 1024 children

ObjectiveThis study sought to summarize the experience of diagnosis and treatment of tracheobronchial foreign bodies in children to effectively reduce complications and mortality. MethodsThe medical records of 1024 pediatric patients admitted to our hospital from January 1997 to September 2011 and diagnosed with clinically suspected tracheobronchial foreign body aspiration were retrospectively analyzed. ResultsOf the 1024 children patients, 674 were boys (65.8%) and 350 girls (34.2%). Two died of respiratory and circulatory failure (foreign bodies detected upon bronchoscopy but not retrieved) before surgery, 65 patients underwent direct bronchoscopic removal of foreign bodies due to their critical status, and 957 received chest radiographs and chest fluoroscopy or multidetector spiral computed tomographic scans (941 positive). Foreign bodies were expectorated before surgery in 3 cases. There were 953 cases of bronchoscopically proven airway foreign body aspiration, with a diagnostic accuracy of 94.5%. Ninety-eight foreign bodies were lodged in the main bronchus and/or bilateral bronchi, 506 in the right main bronchus, and 349 in the left main bronchus. Atelectasis was noted in 42 patients, including 11 with pulmonary consolidation, whose lungs were re-expanded by endobronchial lavage and sputum aspiration. In 3 patients with bronchiectasis, conservative treatment following foreign body removal was followed by no improvement, and pulmonary lobectomy was performed. Foreign bodies were successfully extracted at the first bronchoscopic attempt in 948 cases, accounting for 99.7% of the total. However, 3 patients had to undergo another bronchoscopy to remove the foreign bodies. The most common types of foreign bodies were peanuts, melon seeds, and beans. ConclusionsTimely accurate diagnosis and treatment of tracheobronchial foreign bodies in children can avoid delay in treatment and effectively reduce complications and mortality.

Airway Foreign Body in Children

Introduction: Foreign body aspiration is not uncommon in children. It can be associated with significant morbidity and mortality. This study aims to determine and analyze the characteristics of local pediatrics airway foreign body (FB) aspiration. Methods: A retrospective study of medical records from KK hospital (1997-2010) is done. Patient demographics, clinical/investigative findings, duration of hospitalization and complications are analyzed. Results: The sample consisted of 26 patients (eight months - 13 years of age), who underwent rigid bronchoscopy for FB removal over the last 13 years. Seventy-seven percent were three years of age or younger. Peak incidence (61.6%) was at one to two years of age. Nineteen were males and seven were females. The top three clinical presentations were: cough (61.5%), choking (46.2%) and wheezing (42.3%). Decreased air entry (34.6%), tachypnea (26.9%) and no significant findings (23.1%) were the most common features on physical examination. The most common radiographic findings were consolidation (30.8%), presence of a foreign body (23.1%) and no abnormality (23.1%). Aspiration was primarily into the right main bronchus (38.5%), and 61.5% of the FB was organic in nature [principally peanuts (38.5%)]. Mean hospitalization duration was three days. Delayed diagnose in three cases were secondary to mis-diagnoses as croup (n = two) and respiratory tract infection (n = one). Complications were noted in eight cases (30.8%). There was no mortality. Conclusion: High index of suspicion is required in diagnosing airway FB. Physician’s diagnostic acumen is vital in prompt successful treatment. Heightening public’s awareness is the key to prevention of pediatrics FB aspiration.

Sharp Foreign Body Aspiration Patients: Are They Different?

Objective: Compare and contrast patients with sharp foreign body aspiration (FBA) in the airways to other non-sharp FBA in terms of age, social background, presentation, and nature of foreign body. Method: Case series of patients with FBA in airways and the upper digestive tract in multi-centers, between Jan 2004 to Dec 2009. Results: Around 10 percent of patients had sharp FBA in the airway. We noticed that they are overall older. They mostly have the same social background. Most of them gave clear history of sharp FBA. Imaging was useful in the majority of patients. Most sharp FBA happened with the same object. Conclusion: Patients with sharp FBA are different in terms of age, social background, presentation, and nature of FBA when compared to other non-sharp FBA.

Pediatric airway foreign body retrieval: surgical and anesthetic perspectives

Airway foreign body aspiration most commonly occurs in young children and is associated with a high rate of airway distress, morbidity, and mortality. The presenting symptoms of foreign body aspiration range from none to severe airway obstruction, and may often be innocuous and nonspecific. In the absence of a choking or aspiration event, the diagnosis may be delayed for weeks to months and contribute to worsening lung disease. Radiography and high resolution CT scan may contribute to the eventual diagnosis. Bronchoscopy is used to confirm the diagnosis and retrieve the object. The safest method of removing an airway foreign body is by utilizing general anesthesia. Communication between anesthesiologist and surgeon is essential for optimal outcome. The choice between maintenance of spontaneous and controlled ventilation is often based on personal preference and does not appear to affect the outcome of the procedure. Complications are related to the actual obstruction and to the retrieval of the impacted object. The localized inflammation and irritation that result from the impacted object can lead to bronchitis, tracheitis, atelectasis, and pneumonia.

A feeding obturator for a preterm baby with Pierre Robin sequence

The article describes a clinical and laboratory technique for the fabrication of a feeding obturator for a baby with Pierre Robin sequence. Emphasis is placed on the direct fabrication of a preliminary custom tray, preventing thermal trauma to the tissues, and overcoming the danger of airway obstruction or foreign body aspiration. The functional problems associated with a cleft palate and various methods to overcome them are also discussed.

Extracellular matrix remodeling in children with airway foreign-body aspiration.

The purpose of this study was to observe extracellular matrix remodeling in children with airway foreign-body aspiration (FBA) by detecting the expression of matrix metalloproteinase-9 (MMP-9), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), and hydroxyproline (HYP) in bronchoalveolar lavage fluid (BALF). Forty-six children with FBA and 12 control subjects from 2002-2003 were enrolled in this study. The former were divided into three subgroups according to duration of foreign-body (FB) retention (subgroup 1, <7 days; subgroup 2, 7-30 days; subgroup 3, >30 days). Cell count, and levels of MMP-9, TIMP-1, and HYP in BALF were measured. The total number of cells and differential counts detected in BALF did not differ significantly between patients and controls (P > 0.05), while mast cells were found only in the BALF of patients. The positive rates of MMP-9 in controls, subgroup 1, subgroup 2, and subgroup 3 were 33.3%, 62.5%, 80.0%, and 93.3%, respectively, with a significant difference (P = 0.006). The positive rate of TIMP-1 in controls and subgroups 1, 2, and 3 were 33.3%, 62.5%, 80.0%, and 93.3%, respectively, with a significant difference (P < 0.001) as well. HYP levels in subgroups 2 and 3 were significantly more increased than in subgroup 1 and controls (all P < 0.001). Levels of MMP-9, TIMP-1, and HYP in patients were positively correlated with duration of FB retention (all P < 0.05), and levels of MMP-9 and TIMP-1 were also positively correlated with percentage of mast cells in BALF (all P < 0.05). The differences in MMP-9 and TIMP-1 before and after FB removed were not significant (P > 0.05), while HYP levels decreased significantly after FB were removed (P = 0.001). Our findings support the hypothesis that FBA may contribute not only to mechanical airway obstruction, but also possibly to eventual airway remodeling by generation of MMPs and TIMPs.

Anaesthetic management for endoscopy of the pediatric airway

We have developed a modern strategy for the anaesthetic management of the pediatric airway using anaesthetic drugs such as sevoflurane, propofol, mivacurium and remifentanil, together with new techniques including the laryngeal mask. This strategy provides optimal conditions for the examiner and maximum safety for the pediatric patient. The endoscopic investigation of pediatric airways has become important for the diagnosis and treatment of many pediatric diseases, and is often performed with the support of a pediatric anaesthetist. Important indications include acute and chronic stridor, chronic obstructive airway disease, mucoviscidosis and foreign body aspiration. The best and safest techniques are outlined depending on the clinical situation, and the most frequent complications are discussed, e.g. hypoxaemia, respiratory arrest, laryngospasm, bronchial obstruction, pneumothorax and overdosing of local anaesthetic agents.

Methods in instrumentation for removal of airway foreign bodies

The principles of diagnosis and management of airway foreign body aspiration has not changed since the days of Chevalier Jackson. History and physical examination continue to be the most important aspects in diagnosis and management. The development of optical endoscopic equipment and advances in anesthesia has made the treatment safer. This report will discuss the initial evaluation and methods in preparation and surgical treatment of foreign body removal.

Airway foreign bodies in childhood

Objective: To define clinical spectrum of airway foreign body aspiration in children and to evaluate the outcome and complications. Methods: A total of 53 patients (27 girls, 26 boys) with a mean age of 30.0±32.7 months, who aspirated foreign bodies were treated with bronchoscopy were divided into two groups with respect to the time they were diagnosed as early (Group 1, n=22, ≤24 h after aspiration) and late diagnosed group (Group 2, n=31, >24 h after aspiration). The two groups were followed up prospectively for complications. Results: A total of 72% of patients were under a 3-year age group. Choking episode history was reported in 32% of patients but when families were questioned about it more in detail the rate increased to 51%. Acute episode of choking seemed trivial most of the families. Cough (69.8%), decreased breath sounds (52.8%) and wheezing (45.1%) were predominant symptoms. Sunflower seed (32.1%) and peanuts (15.1%) were noted as common aspirated materials. Air trapping (59%) and consolidation (47%) were the most frequent radiological findings especially in the late diagnosed group ( P<0.01). Patients who aspirated organic materials frequently developed pneumonia diagnosed in late period after aspiration. Conclusion: Pediatricians must be conscious to check for foreign body aspiration who have sudden onset of cough and wheezing episode. In any suspicion, a bronchoscopy should be considered even if there is not any positive history for aspiration. Children should be followed up after bronchoscopy for complications.

Tracheobronchial Foreign Body Aspirations in Children

AbstractBetween January 1987 and May 1997, hospital records of 980 children (587 boys and 393 girls) ≤15 years old referred to our clinic for suspected airway foreign body aspiration were reviewed. Rigid bronchoscopy was performed for all patients. Foreign bodies were successfully removed in 918 (93

Plastic bronchitis

This case illustrates an unusual cause of respiratory distress in the pediatric population. A high degree of suspicion is necessary to make the diagnosis of plastic bronchitis. Wheezing and cough will lead to the diagnosis of reactive airway disease and/or foreign body aspiration. Chest radiographs may yield additional information, but the diagnosis is made by bronchoscopy and removal of the casts. Any child with severe respiratory distress refractory to aggressive conventional medical therapy and with a history or radiograph suggestive of plastic bronchitis should be considered a candidate for bronchoscopy. As clinicians, we must always remember the dictum, "All that wheezes is not asthma."