Foreign Body Aspiration Research Articles

A Case of Migratory Foreign Body in Left Bronchus -Scarf Pin.

Tracheobronchial foreign body aspiration is a life threatening emergency which requires immediate medical attention. Foreign body aspiration caused by sharp objects like scarf pins was more common in young girls, possibly due to casual handling of sharp objects. Most of the patients were symptomatic with cough and choking episodes. The penetration and dislodgement was the most commonly reported symptom in the majority of the patients. Here we are presenting a case of a young female with accidental swallowing of sharp scarf, following which she developed throat pain and cough. A detailed radiological examination was performed which showed that a foreign body had migrated into the left bronchus, which was removed with a bronchoscope. This case demonstrates the emergency management of a sharp foreign object that was inhaled into the airway.

Maternal temperament and anxiety sensitivity in children with foreign body aspiration.

Foreign body aspiration is one of the childhood emergencies that thoracic surgeons are interested in, and it can cause morbidity and mortality. Although the relationship between various behavioral problems related to children and foreign body aspiration has been investigated so far, there is no study investigating the relationship between maternal temperament and anxiety sensitivity. This study aimed to investigate the relationship between maternal emotional temperament, anxiety sensitivity, and foreign body aspiration. Mothers of 18 children with foreign body aspiration have been evaluated by a thoracic surgeon, and 18 healthy controls have also been included in the study. Maternal emotional temperament has been measured with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego - Auto questionnaire scale, and anxiety sensitivity has been measured with the Anxiety Sensitivity Index-3. There has been no statistically significant difference between groups in terms of maternal emotional temperament and anxiety sensitivity. In the logistic regression analysis conducted to determine the predictors of foreign body aspiration, it is determined that the mother's anxious temperament has predicted foreign body aspiration significantly. As a result of the study, it can be concluded that mothers' anxious temperament can be considered a risk factor for foreign body aspiration because it affects parenting skills and children's ability to manage behavioral problems. Consistent results could be able to be obtained with studies including larger samples on the subject.

Anesthetic concerns during rigid bronchoscopy for the management of a friable vegetative foreign body in an infant

Tracheobronchial foreign-body (FB) aspiration is a commonly encountered entity in the pediatric population. FB aspiration (FBA) is an emergency condition requiring early recognition and management, and the primary treatment is the surgical removal of FB under anesthesia. Herein, we report a unique case of an infant developing prolonged severe respiratory distress due to obstruction following a vegetative FBA and shall also discuss the related anesthetic concerns.

FOREIGN BODY ASPIRATION AND INGESTION IN CHILDREN.

Aspiration and ingestion of a foreign body is most frequently seen in children younger than 3 years. Foreign body aspiration is always a life-threatening, urgent state demanding quick recognition and treatment to avoid potentially lethal complications. Most foreign bodies that are ingested pass spontaneously through the gastrointestinal tract without complications, however, some could lead to problems if they become lodged. A literature review was performed via MEDLINE database using key terms. Primary care providers should be trained to give proper initial care. Aspirated/ingested foreign bodies in children removed by rigid or flexible bronchoscopy/gastroscopy always are challenging procedures that require well-planned anesthesia management and excellent intercommunication between anesthesiologists and surgeons. Extracorporeal membrane oxygenation can be used as a rescue mode of support in children with life-threatening foreign body aspiration for stabilization before, during and after removal of the aspirated foreign body. It is of utmost importance that all foreign body extractions, if possible, be done in centers supplied with all the necessary equipment and trained personnel. However, prevention of foreign body aspiration and ingestion is still the best therapy.

Foreign body in the right bronchus in an infant

In children under 2 years of age, foreign body aspiration is common, but sometimes there is no clinical presence that can determine or rule out the diagnosis. It presents with a sudden episode in a child known to be healthy and begins with symptoms of severe respiratory distress, even leading to a fatal event. This picture can go unnoticed by parents or caregivers. The purpose of presenting this case was to define the clinical characteristics of foreign body aspiration in the pediatric population and to assess the importance of the delay in its diagnosis and treatment. Clinical case of a 1-8/12-year-old boy who was admitted to the emergency room due to probably viral pneumonia, with a negative COVID 19 test, pulmonary deterioration, entered the PICU with management and diagnosis of an organic foreign body in the right bronchus (bean), with total atelectasis of the right lung, with resolution of flexible and rigid bronchoscopy.

Dijagnostika i terapija hroničnog kašlja

A cough that lasts for more than 8 weeks in adults (those older than 15 years) and more than 4 weeks in children is considered chronic and poses a significant health problem, as it can lead to feelings of fatigue, sleep disturbances, hoarseness, disruption of daily activities, vomiting, and often in women, even incontinence. The differential diagnosis of chronic cough in adults and children has its specificities. In certain cases, the etiological factor remains unknown when referring to unexplained (idiopathic) chronic cough. This paper presents the results of a systematic review of publications in medical databases (PubMed) and guidelines from the European Respiratory Society (ERS) and the American College of Chest Physicians (CHEST), related to the diagnosis and treatment of chronic cough. Diagnostic investigations should be focused on the most common causes of chronic cough. In adults, these include asthma, chronic obstructive pulmonary disease, bronchiectasis, interstitial lung disease, lung malignancy, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease, and upper airway cough syndrome. In children, the most common causes of chronic cough are asthma, protracted bacterial bronchitis, cystic fibrosis, primary ciliary dyskinesia, bronchiectasis, tracheobronchomalacia, pertussis, habitual (psychogenic) cough, and foreign body aspiration. The treatment primarily involves excluding medications that might have chronic cough as an adverse effect. Therapy is directed toward treating the underlying cause of chronic cough. If the cough persists despite treatment (refractory cough) or if it's idiopathic, neuromodulatory medications are employed (opioids, gamma-aminobutyric acid analogs, tricyclic antidepressants). Therapeutic options also include breathing and vocal techniques, superior laryngeal nerve blocks, and vocal cord medialization injections. Drugs directly inhibiting sensory receptors (P2X3, TRPV-1, and NK-1 inhibitors) are currently under clinical trial investigation. The use of validated tests is crucial for assessing therapeutic effectiveness. The etiological factors of chronic cough can have both infectious and non-infectious origins and are not always related to lung diseases. Considering that chronic cough is regarded as a condition of hypersensitivity, when causal treatment does not yield satisfactory results or when dealing with idiopathic chronic cough, therapy is directed towards central or peripheral neuromodulation, as well as techniques involving breathing and vocal production.

Surgical Emergencies in the ICU.

Surgical emergencies are common in the critical care setting and require prompt diagnosis and management. Here, we discuss some of the surgical emergencies involving the gastrointestinal, hepatobiliary, and genitourinary sites. In addition, foreign body aspiration and necrotizing soft-tissue infections have been elaborated. Clinicians should be aware of the risk factors, keys examination findings, diagnostic modalities, and medical as well as surgical treatment options for these potentially fatal illnesses.

Usefulness of virtual autopsy in diagnosing pathologies in the paediatric population: A systematic review.

Virtual autopsy is a non-invasive/minimally invasive method for conducting an autopsy, with the assistance of imaging techniques. We aim to review the benefits of virtual autopsy in detecting pathologies in the paediatric population. The procedure adhered to Institute of Medicine and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Seven databases including MEDLINE and SCOPUS were searched for articles published 2010-2020 worldwide in English. A narrative synthesis of the findings of included studies was carried out to discuss and summarize the results of the review. From 686 studies on paediatric deaths, 23 met selection/quality criteria. Virtual autopsy was better than conventional autopsy in detecting skeletal lesions and bullet trajectory, thus a crucial tool in the investigation of traumatic and firearm deaths. Virtual autopsy was superior to conventional autopsy in identifying the point of bleeding in postoperative deaths and objectively quantifying air/fluid in body cavities. Virtual autopsy was a useful adjunct for detecting pulmonary thrombo-embolism, foreign body aspiration, drowning and metastatic malignancies. The use of non-contrast imaging in investigating natural paediatric deaths did not offer more information than conventional autopsy. Misinterpretation of normal post-mortem changes as pathological findings was another disadvantage of virtual autopsy leading to erroneous conclusions. But accuracy may be improved with contrast enhancement and post-mortem magnetic resonance imaging. Virtual autopsy is a crucial tool in the investigation of traumatic and firearm deaths in the paediatric population. Virtual autopsy will be useful as an adjunct to conventional autopsy in asphyxial deaths, stillbirths and decomposed bodies. Virtual autopsy has limited value in differentiating antemortem and post-mortem changes with the added risk of misinterpretations, therefore should be used with caution in natural deaths.

Acute management of pneumonia in adult patients.

Acute management of pneumonia in adult patients.

Type II Myocardial Infarction and Stress Cardiomyopathy Secondary to Inhaled Foreign Body (Garden Pea)

Abstract A foreign body aspiration is an unusual event in the adult population, outside of known risk factors such as neurological disease. It typically presents as "cough (67%), dyspnoea (28%), chest pain, cyanosis, stridor or obstruction" and "wheezing (12.7%) and haemoptysis (23.3%)". The authors present the case of inhaled foreign body (pea) in a 69-year-old lady, without underlying risk factors for aspiration. On admission, she was tachypnoeic and unable to speak in full sentences. Her Computerised tomography (CT) scan showed ground-glass changes and potentially superimposed infective changes. Whilst awaiting transfer for bronchoscopy, she developed severe respiratory distress with cardiovascular compromise (new left bundle branch block (LBBB), tachycardia and hypertension). She was intubated in extremis and commenced on noradrenaline. Her angiogram showed mild non-obstructive disease, and she was diagnosed with a type two myocardial infarction and stress-induced cardiomyopathy. The pea was later removed on intensive care via flexible-bronchoscopy. Learning points include the potential for patients with a foreign body to acutely deteriorate, hence the need for urgent bronchoscopic removal and the potential to develop myocardial ischaemia secondary to acute respiratory distress.

SYSTEMATIC REVIEW OF FOREIGN BODY INGESTION

Background: Foreign body ingestion is a predominant worry in pediatric population, with up to 75% of cases happening in childrenyounger than 4 years of age. Pediatric population consume a wide scope of foreign bodies, some of which are more perilous and hazardous than others. Objective: A growing number of research on foreign body ingestion in children nevertheless, there is no clear consensus on signs, symptoms, complications and management of foreign body ingestion among pediatric population. The goal of this systematic review was to determine the significance of foreign body ingestion in pediatric population as far as impaction site, signs and symptoms, and techniques for expulsion. Methods: Authors began with recognizing the important examination proof that spots light on the significance of foreign body ingestion in pediatric population as far as impaction site, signs and symptoms, and techniques for expulsion. We led electronic writing look in the accompanying data sets: Ovid Medline (2015 to present), Ovid Medline Daily Update, Ovid Medline in process and other non-filed references, Ovid Embase (2015 to present), The Cochrane Library (latest issue) and Web of Science. Just examinations in English language will be incorporated. The precise selection was acted in close collaboration with a clinical examination curator. Results: A total of 3503 children with foreign body aspiration were identified from 11 studies (Table in supplementary document). Studies were reported from different places around the world. One study were from Kingdom of Saudi Arabia. Among study participants, there were 2040 males (58.23%) and 1463 females (14.77%). The most common ingested foreign body was coin in six studies. The most common site for impaction of foreign body was esophagus as reported in five studies. Endoscopy was used in as a method of extraction. Conclusion: Children are prone to ingesting foreign bodies. Depending on the type of foreign body, location, and length of impaction, patients may appear asymptomatically or symptomatically with a wide range of symptoms.

A Case of Bilateral Bronchial Foreign Body

Foreign body (FB) aspiration remains a serious health problem, particularly in children. The complications due to occlusion by FB or related to procedures for removal can lead to morbidity and mortality. Most of the FBs are located in the unilateral bronchus, however, the organic FB can be multiple or bilaterally located when children chewed the FB. Here, we present a case of successful retrieval of bilateral bronchial FBs. Preoperatively, FB in the left main bronchus was diagnosed, however, FB of the right upper bronchus was not definitive on X-ray and CT scan. During the rigid bronchoscopy, occult FB in the right upper bronchus was detected and successfully removed.

The survey on foreign body ingestion and aspiration during the dental prosthetic treatment

The survey on foreign body ingestion and aspiration during the dental prosthetic treatment

The Role of Computed Tomography in Diagnosing and Treating Community-Acquired Bacterial or Viral Pneumonia in Children

Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality of choice. Computed tomography (CT) on the other hand, is not currently a first-line imaging tool for children with suspected uncomplicated community-acquired pneumonia and is largely reserved for when complications of pneumonia are suspected or there is difficulty in differentiating pneumonia from other pathology. This review outlines the situations where CT needs to be considered in children with pneumonia, describes the imaging features of the parenchymal and pleural complications of pneumonia, discusses how CT may have a wider role in developing countries where human immunodeficiency virus (HIV) and tuberculosis are prevalent, makes note of the role of CT scanning for identifying missed foreign body aspiration and, lastly, addresses radiation concerns.

Parental Role in Recognition, Prevention and First Aid Management of Foreign Body Aspiration amongst Children

Background: Foreign body aspiration (FBA) is a commonly observed, fatal but preventable condition in children. To reduce the incidence of FBA, it is essential to provide parents with knowledge and guidelines regarding the prevention and management of FBA. Objectives: To assess parental knowledge and parental role in the prevention and first aid management of foreign body aspiration in children. Methods: A descriptive cross-sectional study was carried out at Mayo Hospital, Lahore from January 2019 to September 2019. After IRB approval and informed consent, 151 parents were enrolled through convenient sampling. Data were recorded in a structured questionnaire and analyzed through SPSS version 26. Results: Breathlessness and vomiting were recognized as symptoms of FBA by 49.7% & 7.3% of parents respectively. Hand clutched to throat, color & voice change were recognized as signs by 6.6 %, 9.9 % &10.6 % of the parents. As a first aid measure, 66.2% of individuals knew about back slaps, while only 2% were aware of abdominal thrusts. Literate parents were well aware of the facts that children under the age of three should not consume seeds, hazelnuts, and hard nuts and the child should not laugh or talk while eating compared to illiterate parents (p<0.05) Conclusion: The majority of the parents are not well aware of signs, symptoms, preventive measures and first aid measurements regarding FBA.

Association of orthodontic treatment and aspiration pneumonia

Foreign body aspiration or ingestion is an uncommon potential complication during orthodontic dentistry, and it can produce a medical emergency. Obstruction of the airways can be life-threatening, and delayed recognition and management can result in pulmonary complications such as recurrent pneumonia. Dental treatment has been identified as an important cause of the misplacement of foreign bodies in the airway. Objects used in orthodontic treatment are mainly used due to their manufacturing limitations, such as their shape and size, and because they are made of radiolucent materials, which make them easy to aspirate or ingest and difficult to detect with a radiograph. However, few reports have been published on orthodontic dentistry-related foreign body aspiration and pulmonary complications. Furthermore, micro-aspiration due to poor oral hygiene in patients undergoing orthodontic procedures has been investigated in this review since poor oral hygiene is a well-established risk factor for aspiration pneumonia in the elderly population. The association between the aspiration of orthodontic material and aspiration pneumonia is not well established. Aspiration pneumonia is a secondary symptom of misdiagnosis or delayed diagnosis of dental material aspiration. Additionally, poor oral hygiene can also increase the risk of aspiration pneumonia in elderly patients since poor oral hygiene during orthodontic treatment leads to plaque retention, which can lead to increased development of hyperplastic gingivitis and periodontal breakdown, established risk factor for aspiration pneumonia.

Foreign Body Aspiration Complicated by Pneumothorax in Children: HCUP-KID Perspective.

Children with airway foreign bodies (AFB) occasionally have pneumothorax complicating their course. We aimed to compare the clinical course of these children to those without this complication. Data was obtained from the 2016 Kids' Inpatient Database of Healthcare Cost Utilization Project. ICD-10 code of T17XXXX was used to locate records. They were grouped based on the presence of preoperative pneumothorax, postoperative pneumothorax, or none. Variables included demographics, AFB type, AFB location, length of stay (LOS), pneumothorax treatment modality, mortality, hospital setting, primary payor, and total charges. A total of 4165 children with AFB were identified, 57.8% male and 42.2% female. Of these 75 (1.8%) patients presented with preoperative pneumothorax, 29 (0.7%) with postoperative pneumothorax, and 4061 (97.5%) with no pneumothorax. The preoperative pneumothorax patients were older than the postoperative pneumothorax and unaffected AFB patients (mean age = 9.5 [95% CI 7.7-11.3] vs 8.2 [95% CI 5.4-11.1] vs 5.5 [95% CI 5.3-5.7]; P < .001). Preoperative pneumothorax patients incurred higher total charges than the other groups (mean US = $939K [95% Cl 673K-1,204K] vs $599K [95% Cl 377K-821K] vs $228K [95% Cl 211K-244K]; P < .001), had a longer LOS in days (mean = 37.7 [95% Cl 28.7-46.7] vs 31.6 [95% Cl 16.9-46.2] vs 15.8 [95% CI 15.0-16.7]; P < .001), and had a higher mortality rate (16% vs 0% vs 3.7%, P < .001). Pneumothorax can significantly impact a child's hospital course, and preoperative pneumothorax should alert clinicians to the potential for increased mortality risk.

Foreign Body Aspiration in Children: Review of 198 Cases from Anesthesiology Perspective

Background: Tracheobronchial foreign body aspiration is an emergency in childhood. Rigid bronchoscopy is used for diagnosis and treatment. In our retrospective study, we aimed to evaluate anesthesia man-agement, age, gender, intraoperative blood pressure, pulse, saturation, intraoperative and postoperative complications, foreign body type and localization and length of hospitalization.Materials and Methods: The file of 198 pediatric patients who underwent rigid bronchoscopy by pediatric surgery with the diagnosis of foreign body aspiration in Harran University Medical Faculty Hospital be-tween 2016-2018 were retrospectively analyzed. All cases were managed under general anesthesia. The anesthesia management, age, gender, intraoperative blood pressure, pulse, saturation, intraoperative and postoperative complications, foreign body and localization, length of stay were obtained from patient records and retrospectively evaluated.Results: Localization of foreign bodies were found to be 4.5% in trachea, 48% in right main bronchus and 33.9% in the left main bronchus. 25.3% of foreign bodies were seed, 25.62% were peanuts and 5.62% were organic substances such as beans, needle was removed in 7.6% cases, and toy pieces was removed in 9.6% cases respectively. Low levels of saturation, hypercarbia, arrhythmia, laryngospasm and bron-chospasm were observed as complications of anesthesia.Conclusions: Foreign body aspiration is an emergency that requires early diagnosis and urgent interven-tion. It is important to be aware of the complications that may occur during anesthesia and momentous to be intervened by an experienced team.

Surgical Treatment of Congenital Bronchiectasis in Childhood

Background and purpose: Congenital bronchiectasis (CB) is still an important problem for certain serious pulmonary infections. Surgical treatment of childhood CB has not been discussed extensively because of decline in prevalence and increased experience dealng with this disease. Although the incidence has declined over the past years in societies with high socioeconomic status, CB is still an important health problem in our country. This disease can be diffuse or focal. Diffuse CB is thought to occur owing to underlying systemic illness that causes abnormalities in airway clearance. For patients with bilateral disease, lung transplantation would be the only probable surgical approach. For patients with focal disease, conversely, the removal of the diseased lung had played the main role in the treatment of this disease. Recently, it has been shown that patients with an earlier and more localized disease can be successfully controlled by conservative approaches. It remains controversial as to which children would benefit from surgery and surgical points that may affect the outcome. Therefore, a retrospective study was conducted to evaluate the results of surgical treatment of CB in children. Patients and Methods: We retrospectively reviewed the medical records of 79 consecutive children who underwent surgery for CB in our clinic between 2006 and 2021. Patient demographics, clinical features, radiologic examinations, details of surgery including type of resection, operative morbidity, mortality and outcomes were analyxed. Results: Seventy-nine patients underwent 83 pulmonary resections during the study period. The mean ages at diagnosis of CB and at the time of surgery were 8.10 ± 4.10 years (range, 1 to 17 years) and 9.70 ± 4.20 years (range, 2 to 18 years), respectively. There were 44 males (55.7%) and 35 females (44.3%). The causes of bronchiectasis were congenital hypoplasy of bronchi (n = 31), secondary bronchiectasis was additional nonspecific pulmonary infection (n = 42) and foreign body aspiration (n = 6). Chest X-rays, bronchography and bronchoscopy (n = 79), chest HRCT (n = 61), angiopulmonography (n = 23) were used, and pulmonary function tests (n = 48) were performed. The types of resections were segmenectomy (26.5%), lobectomy (35.4%), and lobectomy with segmentectomy (17.8%), bilobectomy (8.9%) and pneumonectomy (11.4%). Four patients with bilateral bronchiectasis subsequently required second operation for the other lung. Two of those had undergone right lower lobectomy, by one child underwent right upper lobe, and another left lower lobectomies. One patient with incomplete resection subsequently required second operation for ongoing bronchiectasis underwent complementary right pneumonectomy. Morphological study (n=39) Postoperative complications were encountered in 6 patients (7.6%). In terms of long-term outcomes of treatment 78 (98.7%) patients were followed-up at least 6 months up to 14 years. The postoperative status of the patients as follows: “well” in - 49 patients (60.7%), “improved” in 23 patients (29.5%), “ orsened” in 6 patients (7.7%). And unfortunately two patients “died” (2.6%). Conclusions: The decision for bronchiectasis surgery should be made in cooperation with the chest diseases unit. Anatomic localization of the disease should be mapped clearly by radiologic and angiographic investigations. A radiologic and morphologic evidence of reversal of airway abnormality has been shown in cases of post-infectious bronchiectasis and congenital defects of bronchial wall. The morbidity and mortality rates of bronchiectasis surgery are within acceptable ranges. Most of the children benefit from surgery, especially when complete excision is accomplished. Segmentectomy and lobectomy are well tolerated in children without increase in morbidity and mortality. Therefore, resection of damaged part of the lung tissue may be preferred instead of removing high volume lung tissue.

Risk Factors for Lower Respiratory Tract Infection Associated With Tracheobronchial Foreign Body Aspiration in Children.

Tracheobronchial foreign body aspiration (TFBA) is a major cause of accidental death in children. Lower respiratory tract infection (LRTI) may be caused by TFBA, but there are few reports about LRTI associated with TFBA. This study collected TFBA cases in our hospital to analyze LRTI and determine its risk factors. A total of 194 children who underwent tracheobronchial foreign body (TFB) extraction in The Children's Hospital of Zhejiang University School of Medicine from June 2019 to April 2020 were enrolled. CT chest is routinely used in the workup of suspected airway FB at our institution to evaluate for patients, a FB was already highly suspected. The retention time was defined as from the time of TFB inhalation or presentation (if there was no history of TFBA) to the time of TFB removal. General characteristics including weight, clinical symptoms, operative records, cervicothoracic CT, retention time, type of TFB and postoperative hospitalization time were collected. Chi-square tests, rank sum tests and multivariate logistic regression analyses were performed. The incidence of LRTI was 46.6%, 68.6%, and 68.6% when the retention time was within 24 hours, between 24 hours and up to 1 week and more than 1 week, respectively. Postoperative hospitalization time of LRTI group was significantly longer than that of non-LRTI group. Findings for cervicothoracic CT as pneumonia, emphysema, atelectasis meant more serious clinical manifestations and the retention time was longer in the LRTI group than in the non-LRTI group. There was a positive correlation between the retention time of a TFB and LRTI in multivariate logistic regression analysis. The incidence of LRTI caused by TFBA is high. LRTI is association with longer postoperative hospitalization time. The TFB retention time is an independent risk factor for LRTI. If a patient presents with significant LRTI symptoms, a course of steroids and antibiotics maybe a safer approach rather than proceeding immediately with bronchoscopic removal.