Bronchoscopy For Foreign Body Removal Research Articles

Foreign body removal in children: Recommendations versus real life-A survey of current clinical management in Germany.

Task forces of the European Respiratory Society (ERS, 2003) and the American Thoracic Society (ATS, 2015) both recommend rigid bronchoscopy for foreign body removal in children. However, there is an increasing number of publications recommending flexible bronchoscopy as primary method for foreign body removal in children. We therefore initiated a nationwide survey, investigating the routinely used method of foreign body removal in children in different centers in Germany. In total, 259 centers took part in the survey. Twenty percent used flexible bronchoscopy as primary method of choice for foreign body removal. Of note, only 40% of the respondents reported that they had attended formal training courses in flexible bronchoscopy, 15% in rigid bronchoscopy, and 42% had never attended a formal training. Twenty-five percent indicated that they had already encountered an emergency situation during or after foreign body removal, requiring intensive care. Published data shows that rigid bronchoscopy involves fewer complications and is more successful in foreign body removal in children. It is consequently questionable, why 20% of the medical centers report a preference for the flexible method. One reason might be the poor availability of rigid bronchoscopy and the difficulty gaining sufficient expertise in rigid bronchoscopy in Germany. Pediatr Pulmonol. 2017;52:656-661. © 2016 Wiley Periodicals, Inc.

Flexible bronchoscopic foreign body removal through the I-gel supraglottic airway -A case report-

Flexible bronchoscopic foreign body removal through the I-gel supraglottic airway -A case report-

Foreign body inhalation in children: clinical presentations and x-ray chest findings

Background: Foreign body aspiration (FBA) is a medical emergency in children. Delay in diagnosis and treatment can cause complications and even deaths are reported. Objective: The aim of this study was to find out clinical features and x-ray findings in patients with FBA. Materials and Methods: A retrospective analysis was done on all patients less than 15 years of age with the discharge diagnosis of FBA from 2011 to 2014 at SMHS Hospital in Kashmir province. Results: Out of 140 patients with FBA, 87 (62%) were male. The mean age was 48 months. The most common clinical findings were history of chocking (77%), decreased breath sounds (42%), wheezing (38%), cough (20%), respiratory distress (15.5%), and fever. CXR was normal in 46% of patients. Air trapping (emphysema) was the most common radiological finding (29.5%) followed by atelectasis (14%) and consolidations (9.2%) and opaque foreign bodies (5.7%). Gram seeds (pulses) were the commonest foreign body (40%). Bronchoscopic removal of foreign body was done successfully in 133 patients (95%). Conclusion: Although FBA in children diagnosed by history, physical examination and radiographic findings, but this finding may be misleading. Negative X-ray chest should not exclude the diagnosis of FBA in children especially with a strong history of FBA. Early bronchoscopic examination will be safe and lifesaving.

Anesthetic Management in a Pediatric Patient Posted for Bronchoscopy

Anesthetic management in a pediatric patient posted for an impacted foreign body in bronchus is quite challenging, Hemorrhage, Tension pneumothorax during rigid bronchoscopy for foreign body removal is a rare but life threatening complication. We hereby present a case of 3yrs old child who underwent bronchoscopy for foreign body removal from bronchus under general anesthesia where hemorrhage and tension pneumothorax was successfully managed.

Real-time video-assisted retrieval of airway foreign body in very young pediatric patients.

ObjectivesAdvancements in medical endoscopy and techniques of rigid bronchoscopy for foreign body removal have enabled higher diagnostic accuracy, reduced morbidity and precise manipulation. However, in pediatric patients, endoscope-combined forceps may be too big to fit into the small sized airway. Here we present our method of endoscope assisted rigid bronchoscopy in pediatric patients and compare the clinical benefits with conventional naked-eye rigid bronchoscopy.MethodsWe used a 2.7 mm, 0° straight endoscope and small caliber grasping forceps with 3.0 to 4.5 mm sized rigid bronchoscopy for very young (<3 years of age) patients of foreign body aspiration. As an assistant held the rigid bronchoscope in situ, the operator could manipulate the endoscope and forceps bimanually. With endoscopic guidance, the foreign body retrieval was performed carefully. The clinical advantages were compared between our endoscope-assisted method (n=29) and the conventional bronchoscopy method (n=33) in terms of operation time and recovery (hospital stay).ResultsBimanual endoscope-assisted rigid bronchoscopy method was technically feasible and safe. The operation time was less, compared to the conventional technique and the patients recovered more quickly. In all cases, our method completely removed the foreign body without need of a second bronchoscopy procedure.ConclusionBimanual endoscope-assisted retrieval of airway foreign body in very young age pediatric patients was superior to the conventional naked-eye method concerning accurate manipulation and safety.

Efficacy and safety of spontaneous ventilation technique using dexmedetomidine for rigid bronchoscopic airway foreign body removal in children

In children, removal of an airway foreign body is usually performed by rigid bronchoscopy under general anesthesia. Debate continues regarding the respiratory mode (spontaneous or controlled ventilation) and appropriate anesthetic drugs. Dexmedetomidine has several desirable pharmacologic properties and appears to be a useful agent for airway surgeries. This study evaluates the efficacy of spontaneous ventilation (SV) technique using dexmedetomidine for bronchoscopic removal of foreign bodies in children. Eighty pediatric patients undergoing rigid bronchoscopy for airway foreign body removal were randomly divided into two groups. In the SV group, dexmedetomidine (4 μg∙kg(-1)) and topical lidocaine (3-5 mg∙kg(-1)) were administered and the patients were breathing spontaneously throughout the procedure. In the manual jet ventilation (MJV) group, anesthesia was induced with fentanyl (2 μg∙kg(-1)), propofol (3-5 mg∙kg(-1)), and succinylcholine (1 mg∙kg(-1)), and MJV was performed. The success rates of foreign body removal, the incidence of body movement and other perioperative adverse events, and hemodynamic changes were similar between the two groups. The SV patients required longer stays in the postanesthesia care unit (P < 0.01) but experienced less coughing (P = 0.029) in the recovery room. Dexmedetomidine may provide appropriately deep anesthesia and ideal conditions for rigid bronchoscopic airway foreign body removal without respiratory depression or hemodynamic instability.

Risk factors associated with hypoxemia during foreign body removal from airways in childhood

ObjectiveThe aim of this study was to analyze the association between variables associated with hypoxemia in children who underwent rigid bronchoscopy for foreign body removal. MethodsFrom April 1993 to April 2011, four hundred and one children who inhaled foreign bodies were included. Apart from descriptive statistics, univariate and multivariate analyses were performed to identify risk factors related to hypoxemia. ResultsAmong the patients aged up to one year, the risk of hypoxemia was five and a half times higher than for patients aged 1 or older (OR=5.6), whereas the risk of patients who underwent foreign body removal using seed type tweezers having hypoxemia was approximately 4 times higher than that of patients who underwent this procedure with other types of tweezers (OR=3.7). Furthermore, for each additional minute in the duration of the procedure, the risk of hypoxemia reached 4% (OR=1.04). ConclusionOur results suggest that children younger than 1 year who require RB seem to be vulnerable to a higher risk of hypoxemia, especially in longer procedures in which seed tweezers are used.

Clinical and radiological characteristics of unrecognized foreign body aspiration into respiratory tract in children

Diagnosing of foreign body aspiration in children is often postponed. The aim of this study was to evaluate complications, clinical signs and radiological presentation of respiratory illness arising from unrecognized foreign body aspiration in pediatric population. The study sample consisted of 33 patients aged from one to 18 years who had undergone bronchoscopy for foreign body removal over the 10 years' period (from 2000 to 2010). Neither their parents nor the pediatricians who had treated these patients before admission to hospital recognized the acute aspiration event. All the children were treated unsuccessfully for a period exceeding 10 days. The retrospective analysis included the history of foreign body aspiration, patients' age, kind of aspirated foreign body, clinical manifestations that led to hospitalization, radiographic findings and the time lapse from the first symptoms to diagnosis proven by endoscopic intervention. The majority of the foreign bodies were organic (93.93%). Broncho-obstructive syndrome, which was the most frequent clinical presentation, was found in 18 (54.55%) patients; pneumonia was diagnosed in 10 (30.30%) patients, four children were referred to hospital due to infiltrative changes with acute broncho-obstructive syndrome and only one child (3.03%) had persistent productive cough. Radiological findings (chest X-rays) were pathological in all patients. Rigid bronchoscopy was performed in 16 (48.49%) patients 10 days after presenting the first symptoms of respiratory illness, in 6 (18.18%) patients within 10-21 days' period and in 11 (33.33%) patients 3 weeks after the first respiratory symptom. Unrecognized foreign body aspiration results in various clinical manifestations and non-responsiveness to the standard therapy applied.

Nebulized lidocaine alone or combined with fentanyl as a premedication to general anesthesia in spontaneously breathing pediatric patients undergoing rigid bronchoscopy

Pediatric bronchoscopy is an intensely stimulating procedure that requires a deep level of anesthesia to prevent hemodynamic overstimulation and straining. Topical anesthesia of the airway may be a beneficial component of the anesthetic technique to achieve adequate depth without residual sedation. Experimental evidence suggests that in addition to its central effects, locally applied opioids elicit potent analgesic effects. Forty-five patients aged 1-6 years scheduled for rigid bronchoscopy for foreign body removal were selected and subjected preoperatively to a nebulizer setting according to its components patients were divided into three groups. Group A: Nebulized solution contains 4 mg·kg(-1) lidocaine 1%. Group B: Nebulized solution contains 4 mg·kg(-1) lidocaine 1% plus 2 μg·kg(-1) fentanyl. Group C: Nebulized solution contains 0.9% normal saline. Anesthesia was induced with 8% sevoflurane in 100% oxygen and maintained with continuous infusion of propofol 200 μg·kg(-1). Increments of 500 μg·kg(-1) propofol were given to the patient in case of straining or coughing. Patients were followed for the hemodynamics, the intraoperative difficulties, postoperative sedation score, time to full wakefulness and the postoperative complications. The hemodynamic parameters were much more stable in the fentanyl group relative to the other two groups. Also, the incidence of intraoperative difficulties was less significantly evident among patients in the fentanyl group (As regards cough P(1) = 0.003, P(2) = 0.0001, As regards the need to manual ventilation P(1) = 0.037, P(2) = 0.001, As regards Propofol increments P(1) = 0.001, P(2) = 0.001 where P(1) refers to the fentanyl group relative to the lidocaine group, and P(2) refers to fentanyl group relative to the placebo group). The postoperative sedation score was significantly higher, and the time to full wakefulness was significantly prolonged among patients in the fentanyl group relative to the other groups (P = 0.0001). It is concluded that preoperative nebulized fentanyl reduces the hemodynamic response to bronchoscopy and decreases the intraoperative coughing in response to surgical manipulation without significant side effects except prolonged time to full wakefulness of 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.

Bronchoscopy for foreign body removal in children: anaesthetic challenges in a tertiary health Centre.

Aim: To evaluate the practice of therapeutic Paediatrics bronchoscopy in our environment; to review the anaesthetic practice in our centre, and compare them with universally accepted standards.Patients and Methods: This is a retrospective review of cases of foreign body aspiration in children treated at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, between 2002 and 2008. Foreign body aspiration was diagnosed clinically and radiologically. Data concerning demography, clinical characteristics, anaesthetics and complications were obtained from the hospital records.Result: A total of 45 patients were studied. They were between the ages of 6 months and 11 years, 29 males and 16 females. A total of 64 procedures were carried out, of which 38 (59.4%) were bronchoscopy. Bronchoscopy was done with Stortz ventilating bronchoscope under general anaesthesia. Repeated doses of suxamethonium were used as muscle relaxant in 92.1% of cases.Conclussion: Rigid bronchoscopy for aspirated foreign body is a safe, effective and often life saving procedure in the hands of experienced anaesthetist and bronchoscopist. A close rapour between the two teams is necessary for a desired outcome.Key words: Foreign body aspiration, Bronchoscopy, Anaesthesia.

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.

Bronchoscopic foreign body removal in a child

Bronchoscopic foreign body removal in a child

Efficacy of manual jet ventilation using Manujet III for bronchoscopic airway foreign body removal in children

Objectives To evaluate the efficacy of a manual jet ventilation device for bronchoscopic removal of foreign bodies in children. Methods 360 children aged from 10 months to 12 years old undergoing rigid bronchoscopy for airway foreign body (FB) removal from February 2005 to June 2009 were included in the study. Patients were randomly divided into three groups of 120 patients per group (S, P and J). In group S, anesthesia was induced with propofol and γ-hydroxybutyrate sodium and maintained by intermittent bolus administration of propofol; the patients were breathing spontaneously throughout the procedure. In group P, anesthesia was induced with propofol (4–5 mg/kg), fentanyl (1–2 μg/kg) and succinylcholine (2 mg/kg). Mechanical ventilation was performed through the side arm of the rigid bronchoscope. In group J, the patient received propofol, fentanyl and succinylcholine as the same doses administered in group P, and manual jet ventilation was performed by using the Manujet III device. Condition for insertion of bronchoscope, occurrence of hypoxemia, successful rate of FB removal, the duration of the operation, the time of emergence and recovery from anesthesia, and perioperative complications (adverse events) were recorded. Results Groups P and J had significantly higher rates of successful bronchoscope insertion ( P < 0.05), significantly higher success rates for FB removal ( P < 0.05), and lower incidences of hypoxemia during intra- and post-operative periods when compared with group S. Perioperative complications were lower ( P < 0.05), duration of operation was shorter, and emergence from anesthesia was faster ( P < 0.05) in groups P and J when compared with group S. Incidences of hypoxemia were lower in Group J when compared with Group P ( P < 0.05). Conclusion This study confirmed the safety and efficacy of performing manual jet ventilation with Manujet III in foreign body removal by rigid bronchoscopy in children.

The Role of Bronchoscopy in Foreign Body Removal in Dogs and Cats: 37 Cases (2000-2008)

Foreign body aspiration is a differential diagnosis for acute or chronic cough that requires medical or surgical management in animals. Success of bronchoscopy in airway foreign body removal is dependent on the size of the animal, duration of clinical signs, and location of the foreign body. Thirty-two dogs and 5 cats with airway foreign bodies identified at the UC Davis Veterinary Medical Teaching Hospital. Retrospective case study evaluating the role of duration of clinical signs and body size in successful bronchoscopic removal of foreign bodies. In addition, radiographic localization of disease was compared with bronchoscopic identification. Bronchoalveolar lavage (BAL) culture and cytologic findings are reported. Bronchoscopy was successful for removal of airway foreign bodies in 76% of animals (24/28 dogs and 2/5 cats), and in dogs was independent of duration of clinical signs or body size. One-third of thoracic radiographs lacked distinctive features of an airway foreign body, and therefore radiography was unable to predict the affected site. BAL fluid at the site of the foreign body contained more neutrophils and more often had intracellular bacteria than lavage fluid from a separate site. Bronchoscopy was successful in removing airway foreign bodies regardless of animal size or long duration of clinical signs. Results of this study confirm the utility of bronchoscopy with lavage in management of suspected foreign bodies, even in the absence of localizing radiographic findings.

The Risk Factors for Hypoxemia in Children Younger Than 5 Years Old Undergoing Rigid Bronchoscopy for Foreign Body Removal

Survey of Anesthesiology: August 2010 - Volume 54 - Issue 4 - p 182-183 doi: 10.1097/01.SA.0000377124.23381.16

Cardiac arrest induced by tension pneumothorax during ventilating bronchoscopy -A case report-

Tension pneumothorax during ventilating bronchoscopy for foreign body removal is a rare but life-threatening complication. The authors present a case of cardiac arrest caused by tension pneumothorax in a 9-month-old girl who underwent ventilating bronchoscopy for foreign body (peanut) removal. Tension pneumothorax was due to tracheobronchial lacerations caused by a bronchoscope. The patient was successfully resuscitated by cardiopulmonary resuscitation and chest tube insertion. The airway injury was effectively repaired by thoracotomy under extracorporeal membrane oxygenation.

The Risk Factors for Hypoxemia in Children Younger than 5 Years Old Undergoing Rigid Bronchoscopy for Foreign Body Removal

The Risk Factors for Hypoxemia in Children Younger than 5 Years Old Undergoing Rigid Bronchoscopy for Foreign Body Removal

The Risk Factors for Hypoxemia in Children Younger than 5 Years Old Undergoing Rigid Bronchoscopy for Foreign Body Removal

Removal of an airway foreign body (FB) is usually performed by rigid bronchoscopy under general anesthesia, but the choice of anesthesia and ventilation techniques varies greatly among anesthesiologists and institutions. Hypoxemia is the most commonly observed adverse event during rigid bronchoscopy. It is influenced by a variety of factors including the patient's medical condition, the type of surgical procedure, and the anesthetic technique. In the current study, we investigated risk factors that statistically correlate with intraoperative or postoperative hypoxemia in young patients undergoing rigid bronchoscopy. From January 2007 to December 2008, 384 children younger than 5-yr-of-age subjected to rigid bronchoscopy for FB removal were included in the study. The detailed clinical information and perioperative adverse events were recorded. Surgical outcomes and incidence of perioperative adverse events were compared among different ventilation modes (spontaneous ventilation, manual intermittent positive pressure ventilation, and manual jet ventilation) and different anesthetic techniques (total IV anesthesia and inhaled anesthesia). An amalgamated dataset was used for the analysis of factors that correlated with perioperative hypoxemia. In children who received total IV anesthesia with spontaneous ventilation during rigid bronchoscopy, we observed more intraoperative body movement and breath holding, significantly longer duration of emergence from anesthesia, lower percentage of successful FB removal, and more postoperative laryngospasm. Children in the manual jet ventilation group had the least occurrence of intraoperative hypoxemia. Five factors strongly correlated with intraoperative hypoxemia. Younger age, plant seed as the type of FB, longer surgical duration, pneumonia before the procedure, and spontaneous ventilation mode significantly increased the risk of intraoperative hypoxemia, whereas manual jet ventilation mode decreased it. Two factors were associated with postoperative hypoxemia: plant seed as a FB and prolonged duration of emergence from anesthesia. We identified risk factors associated with intraoperative or with postoperative hypoxemia in rigid bronchoscopy which included patient age, type of FB, duration of surgical procedure, pneumonia before the procedure, ventilation mode, and duration of emergence from anesthesia. These results provide evidence that will help clinicians to reduce the incidence of hypoxemia in high-risk children.

Prevalence of flexible bronchoscopic removal of foreign bodies in the advanced elderly

to define the likelihood and establish the overall safety and effectiveness of flexible bronchoscopy in the removal of foreign bodies in the advanced elderly compared to those younger. a retrospective case-control analysis. tertiary care academic hospital. 7,089 adults (age >18 years), including 949 (15%) advanced elderly (age >75 years), who underwent flexible bronchoscopy between January 1995 and June 2007. in those patients with foreign body aspiration (FBA) (n = 20), a comparison of multiple clinical characteristics based on defined age groups (group 1, age <75 years and group 2, age >75 years) was performed. FBA requiring bronchoscopic removal was greater than three and a half times more likely in patients aged >75 years compared to those younger (OR 3.78, CI 1.4-10: P <0.05). Flexible bronchoscopy was 87.5% effective in the removal of foreign bodies in the advanced elderly and associated with no increase in adverse events. bronchoscopic removal of foreign bodies is more likely in the advanced elderly when compared to those younger. This implies that this population may be most at risk. Flexible bronchoscopy is a safe and effective initial diagnostic and therapeutic approach in this age group.