Management Of Tracheobronchial Foreign Bodies Research Articles

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.

Challenges in Management of Tracheobronchial Foreign Bodies with Delayed Presentation: An Institutional Experience.

Introduction Airway foreign bodies are emergencies involving multidisciplinary departments like Pediatrics, Aneasthesiology and Otorhinolaryngology. It is always a challenge to diagnose and manage patients who present late to our emergencies. Objective In the present study, we aim to analyze the various challenges faced during the management of tracheobronchial foreign bodies with delayed presentation. Methods A retrospective hospital record-based analysis of patients who presented to us with tracheobronchial foreign bodies from January 2017 to February 2020 was performed. All patients until the age of 16 years old were included in the present study. We assessed the demographics, preoperative, intraoperative and postoperative data of the patients. Results Seventeen patients were analyzed in the study. Among these, 44.4% of the patients had delayed presentation (> 1 month). The majority of the patients had an organic foreign body (Supari or betel nut). All patients underwent rigid bronchoscopy, followed by optical forceps-assisted removal of the foreign body. A total of 82% of the patients had granulations around the foreign body. Conclusion Management of delayed presentation tracheobronchial foreign body is a big challenge for Otorhinolaryngologists. The key factors for preventing complications in the definitive management of tracheobronchial foreign bodies are preoperative planning, multi-discipline teamwork, surgeon expertise and technique.

Management of tracheo-bronchial foreign bodies at a tertiary care hospital in Eastern part of India

Accidental Foreign body aspiration is common in children presenting to emergency outpatient department. Early diagnosis from clinical and radiological investigations is pivotal for successful removal of aspirated foreign body. We here report 35 cases of foreign body aspiration with respect to clinical features, type and location of foreign body, complications during bronchoscopy.To evaluate the clinical presentation, diagnosis & management of tracheo-bronchial foreign bodies in a tertiary care hospitalThis was a retrospective study of 35 cases of foreign body removal done between January2018to January2020. We included those cases that had history of aspiration, sudden onset of breathlessness or choking sensation in a healthy person, recurrent respiratory infections with clinical or radiological evidence, and suspicion of foreign body. Every case was documented with respect to age, sex, nature, site of foreign body lodgement, duration between inhalation or symptoms and admission in a hospital, clinical symptoms and signs, chest radiography findings, results and complications of bronchoscopy.The most common age group was between 1-6 years. Most of the patients attended hospital after 7 days of aspiration without any emergencies. History of aspiration and respiratory distress were the common presentation. Fever was present in those who presented late to the emergency department. About 25 cases (71.4%) had diminished or absent breath sounds followed by 12 cases (50%) of stridor, 15 cases (42.8%) diminished percussion notes. The common radiographic finding is obstructive emphysema and commonest site was right bronchus. Most of the foreign bodies were vegetative in nature.Early investigation with bronchoscopy is warranted when a strong clinical suspicion exists for foreign body aspiration, since bronchoscopy helps to resolve the symptoms quickly and prevent further complications

Management of Tracheobronchial Foreign Bodies in Adults and Children: 117 Cases

Management of Tracheobronchial Foreign Bodies in Adults and Children: 117 Cases

Management of tracheobronchial foreign bodies in a Nigerian tertiary health center

Background: Airway foreign bodies present as emergencies, are not uncommon in developing countries like Nigeria, and can occur in all age groups. They present great difficulties for both parents and medical practitioners in general and the otorhinolaryngologist in particular. Tracheobronchial foreign bodies may endanger the life of the patient depending on the type, size, and location of the foreign body in the airway tract. We aim to look at the management of tracheobronchial foreign bodies and present a maiden article on the management of tracheobronchial foreign bodies in our center. Patients and Methods: This was a retrospective review of all patients seen at the Emergency Unit and Consultant Clinics of the National Ear Care Centre, Kaduna, Nigeria, with diagnosis of foreign bodies in the airway (the tracheobronchial area). Medical records of patients seen between January 1, 2012, and December 31, 2016, were reviewed. Data generated from the case files were analyzed descriptively. Results: Thirty-four patients presented with foreign bodies in the airway. This comprises 25 males and 9 females in a ratio of 2.8:1. Age at presentation ranged between 11 months and 27 years; the mean age was 7.02 ± 5.46 years. The predominant age group affected was 0–9 years. Twelve patients had a preliminary tracheostomy before endoscopic removal of the foreign body. Twenty-seven patients had rigid bronchoscopy and foreign body removal while 3 patients had flexible bronchoscopy, 1 patient had direct laryngoscopy, and 3 patients had tracheoscopy and foreign body removal. Majority of the foreign bodies were plastic in origin. Conclusion: Airway foreign bodies are acute emergencies, especially in pediatric age groups, and the best modality of treatment is endoscopic removal under general anesthesia.

Flexible Bronchoscopy as a Diagnostic and Therapeutic Method in Patients with Tracheobronchial Foreign Body

Objective: To analyze bronchoscopy as a diagnostic and therapeutic method in patients with tracheobronchial foreign body. Methods: We analyzed reports of flexible bronchoscopy with diagnose of tracheobronchial foreign body performed from 2003 to 2013 in S&#227o Salvador Hospital, in Goiania, capital of Goiás. The analysis was based on: sex and age of the patients, airways and foreign body characteristics, foreign body localization, success rate and rate of bleeding. We calculated the frequencies after analyzing the data. Results: We analyzed 26 reports of the studied period and found that 57.7% of the patients were male with median age of 58.83 years old (+—13.79). The airways characteristics were normal in most of the cases. Sputum wasn’t found in 57.69% of the cases. Foreign bodies were located in right bronchus in 88.46% of the cases, and the extraction of them was successful in 80.76% of the cases. The absence of bleeding was reported in 96.15% of the cases. Conclusions: Flexible bronchoscopy is a notably successful method in management of tracheobronchial foreign bodies. Airways characteristics aren’t good indicatives of FB’s presence, once they are normal in most of the times.

Preliminary experience in the management of tracheobronchial foreign bodies in Lagos, Nigeria.

Aspiration of tracheobronchial foreign bodies commonly affects young children, is potentially life threatening and requires early intervention for extraction. Access to facilities and skill manpower for bronchoscopic extraction is however limited in Nigeria. The aim of this study is to describe the experience in our institution with bronchoscopic removal of tracheobronchial foreign bodies and highlight the challenges encountered. This is a retrospective study of all patients referred to the Lagos State University Teaching Hospital with a diagnosis of tracheobronchial foreign body within the period of February 2008 and February 2013. Data extracted from the medical records were age, sex, time interval between aspiration and presentation, location of tracheobronchial foreign body, bronchoscopic technique, complications and outcome. A total of 24 patients were referred and confirmed at bronchoscopy to have tracheobronchial foreign bodies. Mean age was 6.6 + 5 years. Male to female ratio was 1:1. Delayed presentation was common with 22 patients (91.7%) presenting more than 24 hours after aspiration. Aspirated material was inorganic in 17 patients (70.8%) and organic in 7 patients (29.2%). Location of tracheobronchial foreign bodies was right main bronchus in 16 patients (66.7%), left main bronchus in 6 patients (25%) and the trachea in 2 patients (8.3%). Challenges to speedy and safe removal of the foreign bodies were delayed presentation and a limited range of bronchoscopic equipment early in the series which caused prolonged procedures and increased complications. Two mortalities occurred early in the series; one from airway obstruction and the other from respiratory failure caused by tracheobronchial oedema. Extraction of tracheobronchial foreign bodies was faster, more complete and safer later in the series due to a wider range of bronchoscopy equipment which included both flexible and rigid videobronchoscopy with the use of optical forceps. This preliminary experience suggests that an adequate armamentarium of bronchoscopy equipment is required to increase the chances of complete extraction, speed up the procedure and reduce the risk of complications of Tracheobronchial Foreign Bodies in our environment. Delayed presentation increases the difficulty of the procedure so earlier referral of these patients would help reduce the risk involved in their management.

Management of tracheobronchial foreign bodies: a retrospective and prospective study.

(1) To study the presenting complaints or complaints suggestive of foreign bodies in the tracheobronchial tract. (2) To study the clinical findings. (3) To study the correlation between clinical and radiological findings. (4) To study different types of foreign bodies. (5) To study the complications caused by foreign bodies. A total of 115 patients presenting with foreign body aspiration in the tracheobronchial tract were included in the study. Patient characteristics, history, clinical, radiographic and bronchoscopic findings were noted. Foreign bodies in trachea and bronchus were removed by rigid bronchoscopy under general anaesthesia. Jackson rigid bronchoscope with a fibre optic light source and venturi technique anaesthesia was used. In the present study, foreign body aspiration was found to be maximum in the 1-3year old age group. The average time lapse between aspiration of symptoms and presentation was found to be 1-3days. Positive history was given in only 68% cases. Cough and breathlessness were the most common presenting symptoms. The commonest clinical signs were decreased chest movement and air entry on the affected side. Collapse of the affected side was the most common radiological finding. The commonest site of impaction was the right main bronchus. Majority of the foreign bodies were vegetative, peanut being the most common. The commonest complication following foreign body aspiration was atelectasis of the affected lung. Successful removal of foreign bodies was possible in all the patients. In paediatric respiratory compromise, the presence of unilateral diminished breath sounds, a pathological chest X-ray and a clinical triad of cough, choking and wheezing, is a powerful indicator of tracheobronchial foreign body aspiration. Since no single or combined variables can predict foreign body aspiration with full certainty, bronchoscopic exploration must be performed if tracheobronchial foreign body aspiration is suspected.

Value of chest CT in the diagnosis and management of tracheobronchial foreign bodies

The aim of the present study was to investigate the value of chest multidetector computed tomography (CT) in the evaluation of children with suspected foreign body aspiration. Chest CT was performed in 45 consecutive children with suspected foreign body aspiration, and plain chest X-ray was conducted at the same time. Multiplanar reformatted imaging was carried out after multidetector CT. Rigid bronchoscopy and removal of the foreign body was performed under general anesthesia. All 42 patients (100%) with tracheobronchial foreign bodies were identified on chest CT. Three patients avoided unnecessary operations due to negative CT scans. For the patients with tracheobronchial foreign bodies, the occurrence of unilateral hyperlucent lung and post-obstructive lobar or segmental infiltrates on plain chest X-ray was 42.9% (18/42) and 4.8% (2/42), respectively. Twenty-two of the 42 patients (52.4%) had no abnormalities on plain X-ray. The difference between multidetector CT and plain X-ray results was statistically significant (P < 0.001). Surgical plans were designed and appropriate foreign body forceps were selected based on the CT scans. All foreign bodies were removed successfully, and no severe complications were observed. The location, shape, and volume of the foreign bodies found at surgery were consistent with the CT images. The diagnosis of foreign body aspiration of the airway in children can be accomplished by using chest multidetector CT. It is often useful in delineating the exact shape, location, volume and form of a bronchial foreign body and can help the surgeon plan for operative bronchoscopy and safe removal of the foreign body.

Management of tracheobronchial foreign bodies-experience of cardiothoracic department of cardiology institute

Background We report our experience of 3 years in the management of tracheobronchial foreign bodies in our department of cardiothoracic surgery.

Clinical value of chest CT in the diagnosis and management of tracheobronchial foreign bodies

Objective The purpose of this study was to investigate the value of chest CT in the evaluation ofchildren with suspected foreign body aspiration. Methods Chest CT was performed in 45consecutive children with suspected foreign body aspiration. The patients were examined with 16-slice Multidetector CT (MDCT) using 100 ～ 150 kV,30 ～ 50 mA, 1 mm section thickness. 1.2 pitch ratio, and 0.6 ～1.0 mm reconstruction interval. multiplanar reformatted (MPR) imaging were carried out after MDCT examinations. Results Chest CT revealed all foreign bodies in 42 of the 45 patients. Three patients with suspected foreign body aspiration did not show evidence of foreign body on CT,and they were treated with antibiotics for one week. These patients avoided unnecessary operations and recovered completely. The other 42 patients had evidence of foreign bodies in their bronchi. We designed the surgerical plan and selected appropriate foreign body forceps based on the CT scans. All of the foreign bodies were removed successfully, and no severe complications were observed. The location, shape, and volume of the foreign bodies found at surgery were consistent with the CT images. Conclusion The diagnosis of foreign body aspiration of the airwayin children can be accomplished by using chest CT. It is often useful in delineating the exact shape, location, volume and form of a bronchial foreign body and can help the surgeon plan for operative bronchoscopy and safe removal of the foreign body. Key words: Foreign body,aspiration ; Computerized tomography ; Rigid bronchoscopy ;

Re: How we do it: management of tracheobronchial foreign bodies in children

Re: How we do it: management of tracheobronchial foreign bodies in children

How we do it: management of tracheobronchial foreign bodies in children

Foreign body aspiration remains an important pathology in children. Management of airway foreign bodies must be undertaken in specialized units with experienced staff and known protocols. Development and improvement of rigid bronchoscopes, with advances in anaesthesia have increased the efficacy and the safety of removing endotracheal foreign bodies. A video monitor is advantageous in coordinating the procedure and reducing the stress of the team. Utilization of Fogarty's catheters can be beneficial.

Airway Foreign Bodies in Adults

The objective of this study was to evaluate the efficacy of flexible bronchoscopy in the management of tracheobronchial foreign bodies (TFB) in adults (≥16 y) from 1990 through 2002. TFB was defined as the presence of any foreign object below the vocal cords. Patients with gastric aspiration or regurgitation were excluded. We reviewed Mayo Clinic Rochester's medical data retrieval system to obtain information on patients with TFBs. Data abstracted included demographics, clinical symptoms, physical examination findings, bronchoscopic techniques used for extraction, success rates, and complications. A total of 65 adults with TFB aspiration were identified. There were 44 males (68%) and 21 females (32%) with a mean age of 60.8 years. A recognized predisposition to aspiration was evident in 35 patients (54%). The right lower lobe was the most common site for lodgment of aspirated TFB (24 of 65 patients; 37%), followed by the bronchus intermedius in 14 patients (22%), trachea in 7 (11%), left main stem bronchus in 7 (11%), and other locations in the rest. The most common symptom was cough (58 of 65 patients; 89%). The most common finding on physical examination was wheezing, seen in 20 patients (31%). Chest radiographs were obtained in 59 patients (91%) and were abnormal in 54 (92%). TFB was seen or its presence was suggested on the chest radiograph in 19 patients (32%). TFBs extracted included dental pieces in 14 patients (22%), nuts in 12 (18%), corn kernels in 7 (11%), vegetable matter in 7 (11%), bones in 6 (9%), plastic pieces in 4 (6%), pills in 2 (3%), and one each of the following: meat, nail, laryngeal polyp, folded drinking straw, broken piece of an endotracheal tube, broken piece of a voice prosthesis, tracheostomy cleaning brush, foil, surgical staple, surgical pledget, balloon fragment, sunflower seed, and a sewing needle. The flexible bronchoscope was used in 61 of the 65 patients (94%) and was successful in 54 of these patients (89%). Flexible bronchoscopy was unsuccessful in 7 patients, 6 of whom underwent successful TFB extraction by rigid bronchoscopy. One patient required a thoracotomy for the removal of a TFB in the right lower lobe. Complications from bronchoscopy were minimal and consisted of minor bleeding in 3 patients. Flexible bronchoscopic procedures were successful in the extraction of 89% of tracheobronchial foreign bodies in adults. Our experience also indicates that flexible bronchoscopic removal of TFBs in adults can be safely performed with minimal complications.

Management of tracheo-bronchial foreign bodies in children

To review alternative surgical and anaesthetic options in the management of foreign bodies lodged in the tracheobronchial tree in children aged below 10 years. A five year retrospective secondary data analysis. Three hospitals based in Eldoret Municipality, Kenya. Outcome variables included morbidity and mortality. Of the thirty two children studied, 74.1% had bronchoscopy and 25.9% thoracotomy. The overall mortality rate was 3.3%. Foreign bodies in the tracheo-bronchial tree are a major cause of morbidity and mortality in children aged below 10 years. In settings where appropriate equipment is inadequate, timely thoracotomy may be life saving.

Flexible Bronchoscopic Management of Airway Foreign Bodies in Children

To evaluate experience with the flexible bronchoscopic management of tracheobronchial foreign bodies (TFBs) in children (age < or = 16 years). All pediatric bronchoscopies performed by the bronchoscopy section at Mayo Clinic Rochester from 1990 through June 2001 for the suspicion of TFBs were reviewed. Information analyzed included the types of bronchoscope (rigid vs flexible) and techniques used, success rates of extraction of TFBs, and complications. Of the 94 children suspected of having TFBs, 39 children (28 boys and 11 girls; mean age, 47.3 months) were found to have 40 TFBs. The flexible bronchoscope was used exclusively to extract TFBs in 24 patients, and in 2 patients in whom the rigid bronchoscopic procedure was unsuccessful. Flexible bronchoscopy was performed through an endotracheal tube in 19 children. In the other five children, the procedure was accomplished through a laryngeal mask airway (LMA). In two additional patients in whom the rigid bronchoscopic procedure was unsuccessful, the instrument served as a conduit for the passage of the flexible bronchoscope. The extraction instruments employed included ureteral stone baskets and stone forceps. Since 1994, all extractions of TFBs were successfully accomplished with the flexible bronchoscope. Complications occurred in four patients who underwent rigid bronchoscopy, and included postbronchoscopy laryngeal edema manifested by stridor, cough, and respiratory distress. These resolved quickly with medical therapy. Flexible bronchoscopic extraction of pediatric TFBs can be performed safely with minimal risks and complications. In our experience, it was successful in all children in whom it was employed. Nevertheless, we caution that provisions be made to provide immediate rigid bronchoscopic management, should the attempts at flexible bronchoscopic extraction fail.

Management of Tracheobronchial Foreign Bodies in Children: An Update

Tracheobronchial foreign bodies continue to be a source of morbidity and mortality in the pediatric population. Technical advances in anesthesia and equipment have made the removal of these troublesome objects more feasible. Diligence must still be exercised and a coordinated team effort must be employed in order to achieve a satisfactory and safe outcome for the patient. The appropriate use of diagnostic studies and management techniques are discussed.

Flexible fiberoptic bronchoscopy in the management of tracheobronchial foreign bodies in children: The value of a combined approach with open tube bronchoscopy

Fifty-two pediatric patients suspected of having a pulmonary foreign body but in whom there was insufficient evidence to warrant open tube bronchoscopy. In 19% of these patients, foreign bodies were found. Twenty-six percent of patients who had previously had foreign bodies removed and who subsequently underwent flexible bronchoscopy for a variety of indications were found to have residual foreign bodies. Clinically unsuspected foreign bodies were found in 1% of 1,054 additional patients who had flexible bronchoscopy for other reasons. The diagnostic use of the pediatric flexible bronchoscope is a safe, definitive, and cost-effective method for the identification of patients with pulmonary foreign bodies when other techniques yield equivocal or negative results. Patients known to have a foreign body should undergo open tube bronchoscopy for foreign body removal.

A Different Position on Postural Drainage

Law and Kosloske reported in the September 1976 issue (Pediatrics 58:362, 1976) on the use of postural drainage in the management of tracheobronchial foreign bodies. Their results were not as good as those previously reported. They state that they placed the involved portion of the lung in a "dependent" position for postural drainage. It is hard to understand the theoretical background for this particular practice unless, for example, one is dealing with foreign bodies that are lighter than air.

Management of Tracheobronchial Foreign Bodies in Children: A Reevaluation of Postural Drainage and Bronchoscopy

The efficacy of the inhalation-postural drainage technique for removal of aspirated foreign bodies was compared with that of bronchoscopy in 76 children. Twelve of 49 children on postural drainage coughed out the foreign body (25%); the other 37 required bronchoscopy. The foreign body was successfully removed in 56 of 63 children who were bronchoscoped (89%). Our experience suggests that a trial of inhalation-postural drainage, administered in a hospital, may be valuable in the initial management of aspirated foreign bodies. If unsuccessful after several treatments, however, the technique should be abandoned, and bronchoscopy performed. Delay of foreign body removal beyond 24 hours may be associated with increased morbidity and prolonged hospital stay. With recent improvements in pediatric endoscopic instruments, the efficacy of bronchoscopy exceeds 90%.