Foreign Body Aspiration Research Articles

Foreign body aspirations in children and adults

ObjectiveForeign body aspiration (FBA) can be encountered in all age groups, especially in children under 3 years of age. In this study, we aimed to evaluate our results in children and adults who underwent rigid bronchoscopy due to a history of foreign body aspiration. Materials and methodsIn a single-center study, 822 consecutive patients with suspected foreign body aspiration and undergoing rigid bronchoscopy between January 2000 and August 2021 in our clinic were retrospectively evaluated. ResultsThere were 451 (54.9%) male and 371 (45.1%) female patients. The mean age was 8.1 ± 14.0 (range 1 month–84 years). 525 (63.9%) of the cases consisted of cases under 3 years old, including 3 years old. There were 726 (88.3%) pediatric patients (≤18 years old), and 96 (11.7%) adult patients. The most important symptoms were cough in 690 (83.9%) cases and wheezing in 492 (59.9%) cases. The most frequently aspirated foreign bodies in children were sunflower seeds (14.2%, n = 71), food particles (11.4%, n = 57) and needles (52%, n = 10.4). The most frequently aspirated foreign bodies in adults were needles (39.5%, n = 28), non-needle metallic objects (21.1%, n = 15) and food particles (11.3%, n = 8). No mortality was observed in any of the patients who underwent rigid bronchoscopy. ConclusionFBA is higher in children and direct radiological findings are less than in adults. Current findings show that FBAs in children are more difficult to diagnose and more dangerous clinically.

Tracheobronchial Foreign Bodies in Children: Experience From 1,328 Patients in China.

Objective:To analyze the clinical characteristics of tracheobronchial foreign body (FB) cases in a pediatric Chinese population.MethodsThe clinical data of pediatric patients aged 0–18 years old diagnosed with a tracheobronchial FB in the Children's Hospital of Chongqing Medical University between September 2018 and August 2021 were analyzed retrospectively.ResultsAmong 1,328 included cases, 92.09% of patients were <3 years old, the male to female ratio was 1.86:1. The prevalence of tracheobronchial FB was similar between patients living in rural and urban areas and tracheobronchial FBs were more common in winter. The most common presenting symptoms were cough and wheezing. The most common CT findings was local obstruction or tracheobronchial narrowing, followed by obstructive emphysema of lung and pneumonia. The 11.3% of cases that did not report FB aspiration on admission had a longer time to hospital admission and longer hospitalization time than cases reporting FB aspiration (P < 0.05). The most common FB type was nuts (81.17%). FBs were more frequently located in the right bronchus, and 64 (4.82%) cases involved multiple FBs. FBs were expelled by coughing in only 4.07% of cases. For the other cases, FB removal by first bronchoscopy in our hospital was successful and complete in 96.86% of cases. 1.51% of patients had hypoxic ischemic encephalopathy (HIE) and the location of FBs was a possible risk factor for HIE (P < 0.05).ConclusionsTracheobronchial FBs occurred most commonly in children <3 years old. If asphyxia occurs in children which FBs aspirated, emergency treatment is needed to reduce the occurrence of HIE. Rigid bronchoscopy remains the first-line method for FB removal in children.

Knowledge, Attitude and Perceived Confidence of USIM Dental Graduates Towards Management of Medical Emergencies

Medical emergencies can be alarming to any clinicians, but these situations can be managed well if proper preparation has been made. The objectives of this study are to evaluate USIM dental graduate’s knowledge in dealing with medical emergencies in dental practice, to assess perceived level of competency of USIM dental graduate’s in dealing with medical emergencies in dental practice and to determine the need for further improvement in medical emergencies undergraduate training. A standardised questionnaire form consisting of demographic data, experience, knowledge and perceived level of competency of dental practitioner in dealing with medical emergencies were distributed to USIM dental graduate.123 respondents answered the online questionnaire. Around 58.5% of them had experienced medical emergencies during dental treatment. All of them answered correctly on management of hypoglycaemia but only 44.7% answered correctly on management of unresponsive patient and 65% answered correctly on position of syncope patient. Most of the respondents were not confident in administrating intravenous medication (46.3%), handling foreign body aspiration (24.4%) and using Automated External Defibrillator (AED) (38.2%). This study can be used to guide further improvement in medical emergency training for undergraduates and enhancing the proficiency level of the USIM dental graduates.

Knowledge, Attitude and Perceived Confidence of USIM Dental Graduates Towards Management of Medical Emergencies

Medical emergencies can be alarming to any clinicians, but these situations can be managed well if proper preparation has been made. The objectives of this study are to evaluate USIM dental graduate’s knowledge in dealing with medical emergencies in dental practice, to assess perceived level of competency of USIM dental graduate’s in dealing with medical emergencies in dental practice and to determine the need for further improvement in medical emergencies undergraduate training. A standardised questionnaire form consisting of demographic data, experience, knowledge and perceived level of competency of dental practitioner in dealing with medical emergencies were distributed to USIM dental graduate.123 respondents answered the online questionnaire. Around 58.5% of them had experienced medical emergencies during dental treatment. All of them answered correctly on management of hypoglycaemia but only 44.7% answered correctly on management of unresponsive patient and 65% answered correctly on position of syncope patient. Most of the respondents were not confident in administrating intravenous medication (46.3%), handling foreign body aspiration (24.4%) and using Automated External Defibrillator (AED) (38.2%). This study can be used to guide further improvement in medical emergency training for undergraduates and enhancing the proficiency level of the USIM dental graduates.

Variable Presentation of Foreign Body Aspiration in Children: Diagnostic Dilemma

Aim: To determine the frequency of common clinical presentations in children with foreign body aspiration.&#x0D; Methodology: This cross sectional study was done during the period of March, 2017 to Feb, 2018 A total of 84 children with history of foreign body aspiration were included. The data was entered in the proforma which includes history and the common presentation. The study was approved by ethical review board of PUMHSW. Written informed consent was taken from parents/guardian of all participants.&#x0D; Results: The average age of the children was 3.2±1.69 years. There were 52(61.9%) male and 32(38.1%) were female. Frequency of common clinical presentation was repeated attacks of cough 64.3%, respiratory distress 64.3% followed by sudden onset of choking 54.8%, non-responsive to treatment 34.5%, cyanosis 11.9% and with decrease air way breath sound in right and left as well as bilateral lung was 44%, 23.8% and 16.7&amp; respectively. 46.4% had right, 22.6% left and 25% bilateral hyperinflation similarly 17.95 right, 15.5% left lung were collapse.&#x0D; Conclusion: Beetle nut as foreign body inhalation is more common in children. Repeated attacks of cough, respiratory distress, and chocking are the commonest symptoms. FBA should be kept in differential diagnosis of persistent cough in children.

Accidental Foreign Body Aspiration Through Tracheostomy Inlet; 26 cases.

Foreign body aspiration from tracheostomy is very rare, and materials related to tracheostomy are usually aspirated. This condition, which can lead to serious complications, can be treated using bronchoscopic procedures. In this study, we aimed to present our clinical experience in foreign body aspiration via tracheostomy. Data from 26 patients who presented to our hospital for foreign body aspiration via tracheostomy from 2006 to 2020 were analyzed retrospectively. Foreign bodies were removed by fiber optic bronchoscopy in 15 (57.7%) cases, by rigid bronchoscopy in 9 (34.6%) cases and both methods were used in 2 (7.7%) cases. During bronchoscopy, local anesthetic procedures were used in 13 (50%) cases and general anesthesia was used in 11 (42.3%) cases. No anesthesia was used in two (7.7%) patients who underwent bronchoscopy under intensive care conditions. While the mean operative time for flexible bronchoscopy was 8.77±0.83 (CI: 26.03-29.43) minutes, the mean operative time for rigid bronchoscopy was 27.73±2.53 (CI: 26.03-29.43) minutes. Both rigid bronchoscopy and fiberoptic bronchoscopy (FOB) have advantages and disadvantages in foreign body removal. In our opinion, it is more reasonable to perform fiber optic bronchoscopy first in patients with a tracheostoma. In the light of our experiences, fiber optic bronchoscopy does not require general anesthesia and the operation time is shorter than rigid bronchoscopy. This feature makes fiber optic bronchoscopy advantageous.

Removal of a Left Upper Lobar Bronchial Foreign Body Using Fogarty Catheter and Rigid Bronchoscope

Airway foreign body aspiration in children can lead to accidental death, due to the foreign body itself or the removal procedure. Depending on its location, removal of the foreign body can be challenging. Here, we present a case of successful removal of a foreign body from the left upper lobar bronchus via ventilating bronchoscopy with a rigid bronchoscope and Fogarty arterial embolectomy catheter. Tracheobronchial foreign bodies in locations that are difficult to reach with forceps, due to an acute angle or the small diameter of the pediatric bronchial tree, can be effectively removed with a Fogarty arterial embolectomy catheter.

Çocuk palyatif bakım hastasında atipik bir yabancı cisim aspirasyonu: olgu sunumu

The foreign body aspiration into the respiratory system is an emergency situation with a high mortality rate, when diagnosis and treatment are delayed which can cause complications and repeated hospitalizations. Although it is especially common in children under the age of five, it can be seen at any age in chronically ill children with neurological problems. However, it is rarely seen in pediatric patients with tracheostomy and dependent on a home mechanical ventilator due to their nutritional style and severe neurological retardation. In this study, foreign body aspiration that developed in a pediatric patient with tracheostomy who was followed up with a home mechanical ventilator and fed from gastrostomy was presented.

Global, regional, and national burden and quality of care index in children and adolescents: A systematic analysis for the global burden of disease study 1990-2017.

PurposeTo express a global view of care quality in major causes of mortality and morbidity in children and adolescencesMethodsWe used primary epidemiologic indicators from the Global Burden of Disease 1990–2017 database. We have created four secondary indices from six primary indices in order to assess the care quality parameters. We conducted a principal component analysis on incidence, prevalence, mortality, Years of Life Lost (YLLs), Years Lived with Disability (YLDs), and Disability Adjusted Life Years (DALYs) to create an index presented by quality-of-care index (QCI) to compare different countries.ResultsThe global QCI scores of respiratory infection, enteric infection, leukemia, foreign body aspiration, asthma, epilepsy, diabetes mellitus, dermatitis, road injury, and neonatal disorders have improved remarkably. These causes showed equal distribution of qualified care for both sexes. The global trend of QCI score for mental health showed a steady pattern during the same time and disparities favoring females was evident. The quality of care for these causes was notably higher in developed areas.ConclusionsThe global QCI revealed a universal growth in major causes of death and morbidity in <20y during 28 years. Quality of care is an associate of the level of country’s development. Despite effective interventions, inequities still remain. Implementation of policies to invest in quality improvement and inequality elimination is needed.

Management of Tracheo-Bronchial Foreign Bodies in Children: Our Experience.

(1) To study the epidemiological profile of the patients. (2) To study the various modalities of investigations to arrive at confirmatory diagnosis. (3) To study the post-operative complications. It was a hospital based prospective study. A total of 36 paediatric patients were included in the study over a duration of 2years (August 2017 to July 2019). Written informed consent was taken from the parent of each patient before performing bronchoscopy. All the patients were subjected to careful clinical examination and investigations required followed by emergency bronchoscopic removal of foreign body. The patients were followed up at 1 and 3months after bronchoscopic removal. Amongst the 36 cases, 12 cases presented with airway emergency which addressed by bronchoscopic removal immediately. 10 cases presented with suggestive history of foreign body aspiration were subjected to clinical and radiological studies followed by bronchoscopic removal. 14 cases were referred from paediatric in-patient department who were being treated for unresolved LRTI. Early intervention is life saving if timely done. Unresolved LRTIs should be looked carefully to address missed foreign bodies. HRCT Thorax with 3-D reconstruction (Virtual Bronchoscopy) helps in exact localization of the foreign body. Experienced team of surgeons and anesthetist along with a ICU support is needed for efficient management.

Where is my tooth? A case multiple cough-induced rib fracture

Rib fracture can occur from cough in presence of osteoporosis, malignancy or renal disease. In absence of these risk factors, it is very rare to happen and we found only few case reports where rib fracture due to cough happened without any risk factors. Our patient had persistent and forceful cough secondary to probable aspiration of foreign body leading to rib fracture. Such cases should always be reviewed thoroughly to evaluate and treat any potential reversible causes.

Traumatic Pneumopericardium and Diffuse Subcutaneous Emphysema in a Child- A Case Report and Review of the Literature

Pneumopericardium is defined as air inside the pericardial space. Pediatric pneumomediastinum and subcutaneous emphysema is an uncommon condition can occur due to various reasons : infection, trauma, foreign body aspiration, coexisting structural lung pathology or iatrogenic. It rarely happens after chest trauma. We are here to report a child 8 year old involved in a tackle during a recreational football game with clinically and radiologically affirmed pneumopericardium and diffuse sub cutaneous emphysema caused by chest trauma that was spontaneously relieved.

Spontaneous Non-Traumatic Emphysema in Toddler: The Neglected Foreign Body

Foreign body aspiration is a major cause of fatality and morbidity in children. The child may present acutely with signs of respiratory distress or chronically with symptoms suggestive of respiratory infection. Variable presentations make it difficult to diagnose a case of foreign body aspiration, especially in the absence of a clear history of aspiration. Subcutaneous emphysema and pneumomediastinum are rare presentations. Here, we report a case of 2-year-old child who presented with non-traumatic extensive neck and upper chest subcutaneous emphysema. Computed tomography revealed there was presence of foreign body in left bronchus. Emergency bronchoscopy found a piece of peanut in the left main bronchus. It was successfully removed and the patient was discharged well after three days.

A systematic review of using flexible bronchoscopy to remove foreign bodies from paediatric patients.

Our aim was to summarise the evidence about flexible bronchoscopy for paediatric airway foreign body aspiration cases. We searched the PubMed database from 1January 2001 to 9 October 2021 for peer-review papers published in English on the use, and success rates, of flexible bronchoscopy as the first-line treatment for foreign body aspiration cases. This process identified 243 potential papers. We studied 23 papers comprising 2588 cases of foreign body aspiration and flexible bronchoscopy successfully removed the foreign bodies in 87.1% of cases. Complication rates were low in the 983 patients studied in 18 papers. The foreign bodies were organic materials in 78.3% of 1371 patients and mainly lodged in the right bronchial tree in 50.5% of 1402 patients. General anaesthesia was used before flexible bronchoscopy in 14/23studies and laryngeal mask airways were mostly used in 10/23studies to secure the airway during the procedure. Ancillary equipment was used to assist the foreign body removal in 57.3% of 1808 cases and these were usually baskets. Flexible bronchoscopy was a feasible and safe therapeutic procedure for selected foreign body aspiration cases. Future studies need to focus on comparing the clinical outcomes of flexible and rigid bronchoscopies.

Perioperative Medicine: Managing for Outcome, 2nd Edition

Perioperative Medicine: Managing for Outcome, 2nd Edition

Peanut Aspiration A Pandemic Peril in Pediatric Population During COVID 19 Lockdown; Rigid Bronchoscopy A Ramrod for Grapple

Recent studies have shown that there is a strong correlation between covid-19 pandemic lockdown and surge in number of cases of Foreign body aspiration [FBA] especially Peanut in paediatric age group. It has been witnessed that foreign body aspiration is seen among children of low socioeconomic strata and migrant population because peanut is most common affordable snacks available during containment. Also it is seen among children of working parents and migrant labours,therefore it goes unwitnessed making diagnosis and treatment late. This review article out sketches the early and late manifestations, clinical evaluation and management of peanut aspirationin paediatric population during pandemic lockdown by timely role of paediatrician and itsretrieval by rigid bronchoscopy performed by otorhinolaryngologist.The best method for diagnosing and conveniently treating FBA is rigid bronchoscopy. In review of many cases of clinically diagnosed FBA, bronchoscopy resulted in a 99% success rate in removing identified foreign objects.

Foreign body aspiration in an adult: An endobronchial "Melon-oma".

Background: Foreign body (FB) aspirations in adults are relatively uncommon. The most commonly aspirated FBs in adults are organic, especially vegetable matter, peanuts, and fragments of bones. We report a rare case of a FB discovered in the left main bronchus of an adult male admitted to the intensive care unit. Case report: A 52-year-old male smoker with COPD presented to the emergency department with a two-day history of increasing dyspnea and cough. He was hypoxic and febrile with a temperature of 38°C. Auscultation revealed decreased breath sounds over the left lung and a few rhonchi on the right side. Chest x-ray showed left lung collapse. His condition rapidly worsened, and he was immediately intubated for acute respiratory failure. CT chest identified a large endobronchial mass obstructing the left main bronchus. Flexible bronchoscopy confirmed a soft and mobile brownish lesion in the left main bronchus. The histological appearance of the specimen retrieved was consistent with an organic foreign body. This was later identified as a melon chunk. It was removed successfully via flexible bronchoscopy by cutting it into smaller pieces to aid retrieval. Conclusion: FB aspiration can occur in all age groups but is less common in adults accounting for only 0.16%–0.33% of adult bronchoscopic procedures. Early detection of an aspirated FB is essential to avoid significant complications, morbidity, and mortality.

Magnet-related foreign body aspiration in two children requiring thoracotomy: A concerning report

With the increase in use of smaller magnets in gadgets and toys at home, magnets pose a growing aspiration risk in children. We present two simultaneous cases of magnet-related foreign body aspiration (FBA) in two children, in two different cities: Karachi, and Lahore. They presented with similar signs and symptoms: tachypnea, tachycardia and asymmetric breath sounds on auscultation. They were initially diagnosed with the help of a chest X ray. Both the cases were complicated by failed bronchoscopy attempts due to the slippery texture of the magnet. Due to the failed bronchoscopy, both patients had a prolonged and complicated course including a 24–48 hour stay in the PICU prior to magnet removal. They eventually had to undergo thoracotomy for successful removal of the magnet. Both had an unremarkable post-operative course and were discharged in good health.

Paediatric airway and challenges during COVID

Paediatric airway brings some unique challenges to anaesthesiologist. Anaesthesiologists are at particularly high risk of being exposed to Covid cases because airway management, particularly tracheal intubation, positive pressure ventilation through a mask, and management of tracheostomy tubes, causes widespread aerosolization of the virus2.But these cases cannot be deferred. The aim of our presentation is to discuss the various challenges we faced managing these presumptive COVID positive pediatric airway cases , not only because of logistic issues but also to optimize the airway and work in a coordinated way with ENT surgeons in the common airway . We present the anaesthetic management of few challenging paediatric cases of tracheobronchial foreign body aspiration, Laryngeal web presenting with stridor, laryngeal papillomatosis during this period April 2020 to September 2021 in our institute.

Features of Technical Problems in Pediatric Rigid Bronchoscopy

Aim: Foreign body aspiration in the respiratory tract in children is a vital problem treated with rigid bronchoscopy (RB). In our study, technical problems and solutions of problems detected during RB were evaluated. Methods: Between August 2019-March 2021, 42 cases, which are operated due to foreign body aspiration, are analyzed in terms of age, gender, nature, and location of foreign body, complications, and technical problems. Results: 42 child patients (20 girls, 22 boys) were admitted to our clinic due to foreign body aspiration the respiratory tract ranged in average age from 1-16 years (average 4.6). Three of the foreign bodies were removed from the right main bronchi, 7 from the left main bronchi, and 4 from the trachea. Thirty-six were organic and 6 were inorganic. Human error was detected in 8 cases, instrument error in 27 cases, device error in 4 cases, and multiple errors in 3 cases. Conclusion: In attempts where tools and devices are used extensively, there are undesirable events and complications due to errors. We believe that analyzing error reports to reduce them is preventative