Bronchoscopy For Foreign Body Aspiration Research Articles

Flexible bronchoscopy for foreign body aspiration in children: A single-centre experience.

The technological evolution of bronchoscopy has led to the widespread adoption of flexible techniques and their use for both diagnostic and therapeutic purposes. Currently, there is an active debate regarding the comparative efficacy and safety of rigid vs flexible bronchoscopy in the treatment of foreign body aspiration. To evaluate our experience with tracheobronchial foreign body extraction using flexible bronchoscopy and provide a literature overview. This was a single-centre retrospective study. Twenty-four patients were enrolled between January 2017 and January 2023. Medical records of patients aged below 18 years who were admitted to authors' affiliated institution with a suspected diagnosis of foreign body aspiration were collected from hospital's database to Microsoft Excel 2019. Data were analysed using MedCalc Statistical Software. Patient ages varied from 9 months to 11 years. The median age was 23.5 months, 95% confidence interval (CI) 19.49-44.77. We observed age clustering in children with foreign body aspiration at our institution with three age subgroups: (1) 0-25 months; (2) 40-60 months; and (3) 120-140 months. We expectancy of an organic tracheobronchial foreign body was significantly higher in 0-25 months subgroup than that in older ones when subgroups 40-60 and 120-140 months were combined together (odds ratio = 10.0, 95%CI: 1.44-29.26, P = 0.0197). Successful foreign body extraction was performed in all cases. Conversion to a rigid bronchoscope was not required in any of the cases. No major complications (massive bleeding, tracheobronchial tree perforation, or asphyxia) were observed. Flexible bronchoscopy is an effective and safe method for tracheobronchial foreign body extraction in children.

The use of rigid bronchoscopy in foreign body aspiration

The use of rigid bronchoscopy in foreign body aspiration

The Effect of COVID-19 Pandemic on Foreign Body Aspiration.

This article evaluates the effect of coronavirus disease 2019 (COVID-19) pandemic on clinical course and management of cases that underwent bronchoscopy for suspected foreign body aspiration (FBA) in children. The patients who underwent bronchoscopy with a presumptive diagnosis of FBA between July 2018 and December 2021 were evaluated for demographic features, clinical findings, management details, and outcomes. Patients were divided in two groups: before pandemic (group A) and during pandemic (group B). In total 79 cases with a median age of 5 years (4-5) in group A (n = 47) and 3 years (2-3) in group B (n = 32) were included (p < 0.05). The witnessed aspiration was significantly higher in group B (90.6%) when compared to group A (53%) (p < 0.05). Admission time was less than 48 hours in 30 cases (64%) in group A and 23 cases (72%) in group B (p = 0.002). The intervention time was less than 24 hours in 30 cases (64%) in group A, 9 cases (28%) in group B (p = 0.002). Bronchoscopy was performed after COVID-19 polymerase chain reaction (PCR) testing in all cases in group B. The positive FBA rate was 38% (n = 18) in group A, and 59% (n = 19) in group B (p = 0.067). During pandemics, bronchoscopy for FBA was performed in younger infants than before pandemic and witnessed aspiration was significantly more common in that period. The differences in age groups and symptoms may be explained by spending more time at home during pandemics. Waiting for the PCR test results causes delays in the intervention. However, this delay did not cause any respiratory distress.

Use of Flexible Bronchoscopy in Foreign Body Aspiration.

Objective:Foreign body aspiration remains a serious health problem with a potential for severe consequences, and acute and chronic problems in children. It therefore demands immediate intervention. Rigid bronchoscopy has long been the method of choice for foreign body removal but is now being replaced by flexible bronchoscopy which offers reduced trauma and the ability to access distal bronchial regions. In the presented study we assessed the patients who underwent flexible bronchoscopy for foreign body removal in our clinic.Methods:We reviewed the records of 20 patients who underwent flexible bronchoscopy due to suspected foreign body aspiration and had a foreign body removed in our clinic. Patients were analyzed in terms of sociodemographic data, foreign bodies removed, method of foreign body removal, foreign body location and time to diagnosis.Results:Our study group included nine females and 11 males. The removed foreign body was organic in 19 of the 20 patients and inorganic in one patient. Hard organic food, such as hazelnuts, peanuts, seeds, almonds, and raw corn kernel were identified in 12 patients, a piece of fishbone in one patient and a piece of gelatin in another. The pieces of soft organic food identified were apple in one patient, egg in one patient, and boiled corn kernel in one patient and removed by suction. The foreign body was removed using forceps in nine patients, and a basket was used successfully in seven patients.Conclusion:Foreign bodies can be removed with minimal complication using flexible bronchoscopy, basket, and forceps in children.

Pediatric Foreign Body Aspiration: Time of Occurrence and Factors Affecting Outcomes.

The goal of this study was to assess which factors could affect outcomes in pediatric patients undergoing bronchoscopy for foreign body aspiration (FBA). This is a retrospective case series study evaluating patients who underwent bronchoscopies because of FBA at a tertiary pediatric hospital between January 1, 2010, and December 6. 2018. Data collected included demographic information, time of the aspiration event, history of developmental delay, time of the procedure, duration of the procedure, and outcome (discharged, admission to the hospital or pediatric intensive care unit [PICU], or deceased). Statistical analysis was performed using standard regression analysis and analysis of variance. There were a total of 114 patients who underwent bronchoscopy for FBA (61% male and 39% female). The mean ± SD age was 2.8 ± 3.4 years, and 16% had developmental delay. The mean age for patients with developmental delay was 3.43 years, compared with 1.69 years for patients without developmental delay. The age difference between these 2 groups was statistically significant (P = 0.0047). The most commonly aspirated object was food (57%), and patients were usually with their parents at the time of aspiration (78%). Most aspiration events (57%) happened between 4 pm to 4 am. The mean ± SD time of procedure was 38 ± 28 minutes. The probability of admission to the hospital, PICU, and death increased with the duration of the procedure (P < 0.001). Patients with procedures longer than 60 minutes had a 40% probability of admission to the PICU, and patients with cases longer than 120 minutes had 13% probability of mortality. Most FBA s occurred in the evening while the children were with their parents. Education of families regarding the risk of aspiration is crucial, so they are always attentive to this issue. Although the focus on prevention tends to be with younger patients, it is essential to emphasize the risk of FBA in older patients with developmental delay. Because most episodes of aspiration occur later in the day, it is imperative that tertiary pediatric centers ensure that the evening staff is trained and have the available equipment for these complex cases.

Evaluation of the Use of Fiberoptic Bronchoscopy Following Rigid Bronchoscopy in Foreign Body Aspiration

Background: Foreign body aspiration (FBA) is a life-threatening problem that can be lethal in some cases. It usually occurs in children between 1–3 years old. Bronchoscopy is the best way for recognition, treatment and management of this problem. We aimed to evaluate the use of fiberoptic bronchoscopy after rigid bronchoscopy in foreign body aspiration in pediatric population. Materials and Methods: 275 pediatric patients with a history of choking were entered to this cross-sectional study, from August 2015 to September 2018. The study was done in a Dr. Sheikh hospital, Mashhad, Iran. The age and gender of the patients were recorded individually. Rigid bronchoscopy was done for all patients. After that, fiberoptic bronchoscopy was performed immediately or 72 hours after the first procedure based on the patients' symptoms, time and personnel conditions. Data were analyzed by the SPSS software version 16.0. Results: Among 275 patients, 175 cases (63.6%) were male. The patients' age was 3 months to 15 years old. In rigid bronchoscopy, 85 cases had no foreign body and in 190 cases, foreign body was found. In 43 cases fiberoptic bronchoscopy found a residual organic material in spite of negative rigid bronchoscopy.The most residual organic material pertained to 0-3 year age group and the cases with residue in males were more than females. There was a significant difference between FBA and age and gender (p <0.001). Conclusion: FBA in airway branches may not be seen by rigid bronchoscope due to the limited access to the distal branches. We suggest fiberoptic bronchoscopy as a complementary management along with rigid bronchoscopy to investigate distal branches, especially if the foreign body is soft in material.

The Impact of COVID-19 Pandemic on Pediatric Bronchoscopy for Foreign Body Aspiration

Aim: As the case number of COVID-19 has grown exponentially around the world, elective surgical operations have been reduced in many centers. However, it is obvious that bronchoscopy performed due to foreign body aspiration in children cannot be delayed. The aim of this study is to investigate the effects of the COVID-19 pandemic on bronchoscopic procedures in children with suspected foreign body aspiration.Methods: Sixty-three patients who admitted to our hospital with suspected foreign body aspiration between 1 January 2016 and 31 December 2020 were included in the study. The patients were divided into two groups according to admission date as those admitted before and after 10 March 2020, in which the first case of COVID-19 has been reported in Turkey. Patients age, gender, history, physical examination findings, thorax radiography and computed tomography findings, the time period between admission to the hospital and bronchoscopy, presence of foreign body in bronchoscopy and complications were evaluated retrospectively from medical records.Results: The study included a total of 63 patients, of whom 48 were in group 1 and 15 in group 2. Foreign body aspiration was more commonly seen in boys in both groups. The mean age of the patients was 38.35 (±37.08) months in group 1 and 27.06 (±38.18) months in group 2. When the two groups were compared in terms of the presence of a foreign body history, physical examination findings, thorax radiography findings and post-procedural complications, no significant differences were found. The time period between admission to the hospital and bronchoscopy was 10.45 (±19.66) hours in group 1 and 35.93 (±32.53) hours in group 2. This period was significantly longer in the group 2 when compared to group 1. Conclusion: Foreign body aspiration in children continues to occur during the COVID-19 pandemic. Bronchoscopy can be performed safely in these patients by taking necessary precautions.

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

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.&#x0D; 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.&#x0D; 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.&#x0D; 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.

CLINICAL ANALYSIS OF COMPARISON BETWEEN FLEXIBLE BRONCHOSCOPY AND VIRTUAL BRONCHOSCOPY IN FOREIGN BODY ASPIRATION

RespirologyVolume 22, Issue S3 p. 233-233 APSR Poster Abstracts CLINICAL ANALYSIS OF COMPARISON BETWEEN FLEXIBLE BRONCHOSCOPY AND VIRTUAL BRONCHOSCOPY IN FOREIGN BODY ASPIRATION First published: 23 November 2017 https://doi.org/10.1111/resp.13207_381Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume22, IssueS3Supplement: 22nd Congress of the Asian Pacific Society of Respirology, International Convention Centre, Sydney, Australia, 23–26 November 2017November 2017Pages 233-233 RelatedInformation

Bronchoscopy for foreign body aspiration and effects of nebulized albuterol and budesonide combination.

Objective:A foreign body aspiration in the tracheobronchial tree is a dangerous medical condition in the childhood period. Although rigid bronchoscopy is a safe procedure, it may cause complications. The aim of this study was to present our bronchoscopy experience and to evaluate the efficacy of pre-operative administration of nebulized albuterol and budesonide combination for reducing intra-operative complications in foreign body aspirated cases.Methods:In this retrospective study our pediatric cases in which a foreign body was removed from tracheobronchial tree in last 8 years were analyzed. After excluding the patients who needed emergent and negative bronchoscopies, the remaining clinically stable 84 patients were compared for the effects of preoperative administration of nebulized albuterol and budesonide combination on bronchoscopy complications.Results:There were 51 boys (60.3%) and 33 girls (39.7%). There were 38 children in the non-nebulized group and 46 children in the nebulized group. We found that the combined albuterol and budesonide nebulization decrease complications such as arterial oxygen desaturation (p<0.05), and bronchospasm (p<0.05) during the bronchoscopic intervention.Conclusion:Preoperative nebulization of albuterol and budesonide combination may decrease perioperative complications of bronchoscopy.

Sugammadex Efficacy for Rapid Reversal of Rocuronium Induced Neuromuscular Blockade in Pediatric Rigid Bronchoscopy Regardless the Depth of Anesthesia

Background: Bronchoscopy may be either rigid or flexible. Rigid bronchoscopy is usually done for diagnosis and treatment of intra and/or extra luminal obstruction in the airway for adults and children, anaesthesia for bronchoscopy poses unique challenges for the anaesthesiologist. This procedure needs specific technical precision because both the anaesthesiologist and operator share the same working space, that is, the airway. Pediatric rigid bronchoscopy needs a deep level of general anesthesia with a good (profound) muscle relaxation for a short time, with the modern anesthetic muscle relaxant rocuronium Bromide and its unique rapid onset it gives chance to be used in challenging airway procedures like rigid bronchoscopy and with the its newly advent of selective reversal, sugamadex, encourage its use in pediatric rigid bronchoscopy as it is usually performed for Foreign body removal. Aim: The aim of this study is to compare the efficacy of sugammadex and neostigmine for reversal of neuromuscular blockade induced by rocuronium for facilitating interventional rigid bronchoscopy and having awake child with good adequate muscle power and good ability to protect airway reflexes. Methods: This study was done on 100 patients ASA1-11 underwent rigid bronchoscopy for foreign body aspiration, we compared the efficiency of both neostigmine and the newly selective reversal agent; sugamadex in recovery of the patients, hemodynamics, and the presence of any side effects. Results: Our results showed that no significant changes between two groups in Table 1, Table 2, Table 3 i.e. heart rate, arterial blood pressure and O2 saturation (%) during all period of study i.e. Base line, Strating study drug, 2 min, 5 min, 10 min. But in Table 4, Table 5, Table 6 i.e. Time (in min) from administration at study drug until recovery (TOF>0.9) , extubation time in min (from administration at study drug until extubation), Recovery time (from administration at study drug until Aldrete score more than 9) the time was significantly shorter in group (1) when compared with group (2) which was (3.6 ± 2.6, 3.9 ± 2.6 and 7.3 ± 1.9) in group (1) and (15.12 ± 1.85, 15.85 ± 1.85 and 19.59 ± 2.3) in group (2). In Table 7, there was no significant difference in the side effects between both groups. Conclusion: Sugammadex achieved significantly faster recovery of rocuronium-induced neuromuscular block when compared with neostigmine regardless the depth of anesthesia. Serious adverse events were less than 1% of patients in both sugammadex and neostigmine, and data showed no differences in risk of serious adverse events between groups. sugammadex was well tolerated.

ÇOCUKLARDA YABANCI CİSİM ASPİRASYONU: TEDAVİ AMAÇLI RİJİD BRONKOSKOPİ SONUÇLARIMIZ

<p class="ql-align-justify"><strong>Introduction:&nbsp;</strong>Rigid bronchoscopy is useful in treatment of foreign body aspiration as well as in many diagnostic procedures. <p class="ql-align-justify"><strong>Patients and Metods:&nbsp;</strong>In this study we aimed to evaluate retrospectively our patients with foreign body aspiration between 2001-2015 in terms of age, gender, type and&nbsp;localisation of aspirated material and&nbsp;complications. <p class="ql-align-justify"><strong>Results:&nbsp;</strong>During this period 168 patients have undergone rigid bronchoscopy for foreign body aspiration. Foreign body was detected and removed in 162 of them. In 17 patients a metallic object, in 33 plastic material and in 112 patients food remains were detected. Post-operatively 3 patients (1.7%) needed intensive care unit. Two children received thoracotomy because of ineffectiveness of rigid bronchoscopy. In six patients (3.6%) foreign body was not detected. <p class="ql-align-justify"><strong>Conclusion:</strong>Rigid bronchoscopy is a reliable and life-saving procedure in pediatric patients for foreign body aspiration.

Foreign Body Inhalation in the Adult Population: Experience of 25,998 Bronchoscopies and Systematic Review of the Literature.

Foreign body aspiration is an uncommon entity in adults. Herein, we describe our experience with flexible bronchoscopy in the removal of tracheobronchial foreign bodies in adults. We also conducted a systematic review of the literature on the topic of foreign body inhalation in adults managed with flexible bronchoscopy. The bronchoscopy database (from 1979 to 2014) was reviewed for subjects > 12 y of age with a history of foreign body aspiration managed with flexible bronchoscopy. Demographic, clinical, and bronchoscopy data were collected and analyzed. PubMed was reviewed for studies describing the use of flexible bronchoscopy for foreign body extraction in adults. During the study period, a total of 25,998 flexible bronchoscopies were performed. Of these, 65 subjects (mean age of 32.8 y, 49 males) were identified who had undergone bronchoscopy for foreign body aspiration. Nonresolving pneumonia (30.6%), direct foreign body visualization (24.6%), and segmental collapse (18.4%) were the most common radiological abnormalities. Foreign bodies were identified in 49 cases during bronchoscopy and successfully removed in 45 (91.8%) subjects with no major complications. Metallic (41%) and organic (25.6%) foreign bodies were the most common. Shark-tooth (44.9%) and alligator (32.6%) were the most commonly used forceps in retrieving the foreign bodies. The systematic review yielded 18 studies (1,554 subjects with foreign body inhalation). In adults, the proportion of flexible bronchoscopy (6 studies, 354/159,074 procedures) performed for the indication of foreign bodies among the total flexible bronchoscopies was 0.24% (95% CI 0.18-0.31). The overall success of flexible bronchoscopy (18 studies, 1,185 subjects) for foreign body extraction was 89.6% (95% CI 86.1-93.2). Foreign body aspiration is a rare indication for flexible bronchoscopy in adults. Flexible bronchoscopy has a high success rate in removal of inhaled foreign body and can be considered the preferred initial procedure for management of airway foreign bodies in adults.

A successful neonatal repair of congenital aortic aneurysm with cleft sternum

minal obstruction may occur. Recurrent suppurative pneumonia can occur due to obstruction. Our patient aspirated a chicken bone 4 years previously and underwent several rigid bronchoscopy attempts to extract the foreign body. She was admitted to the Istanbul Medical School after an episode of pneumonia and had dyspnea and audible wheezing because of near total airway obstruction diagnosed via bronchoscopy. Ibrahim Sersar and colleagues reported a series of 3300 patients, 3 of whom required bronchotomy because extraction of the inhaled foreign body failed. In another study, 164 patients underwent bronchoscopy for foreign body aspiration, and 6% of patients required surgical extraction. Early bronchoscopy has high successful rates in the extraction of foreign bodies. Bronchotomy is usually enough to extract the foreign body, which was performed after early bronchoscopy. Because of the delay in extraction, our patient required an extended operation, a segmental main bronchial resection with supra-aortic anastomosis. After unsuccessful attempts, a bronchotomy would have been a less-invasive procedure for this patient. Thus, we advise an early operation for organic foreign bodies.

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.