Rigid Bronchoscopy For Foreign Body Removal Research Articles

High-flow nasal cannula oxygenation in comparison with apnoeic oxygenation during foreign body removal by rigid bronchoscopy: A randomised controlled trial.

ABSTRACTBackground and Aims:This trial aimed to assess the safety and efficacy of oxygenation using a high-flow nasal cannula (HFNC) compared with the standard apnoeic oxygenation technique during foreign body (FB) removal by a rigid bronchoscope.Methods:A prospective, blinded, randomised, controlled trial was conducted on subjects planned for FB removal by a rigid bronchoscope. Inclusion criteria were male and female patients aged between 10 and 40 years. The primary outcome was the lowest oxygen saturation level monitored by pulse oximeter during the procedure, and the secondary outcome was the incidence of postoperative atelectasis.Results:Nearly 64 patients were randomised into either HFNC oxygenation (N = 32) or apnoeic oxygenation (N = 32) group. There were no significant differences between the studied groups regarding age, gender, weight, or cardiovascular variables. Intraoperative oxygen saturation was 4% higher in the HFNC group at different times. The end-tidal carbon dioxide measured on induction and after termination by 15 min showed no significant differences between the two groups; however, it was significantly higher in the apnoeic oxygenation group immediately after the procedure, after 5 min, and after 10 min of termination. No adverse effects from the increased end-tidal carbon dioxide were reported.Conclusion:HFNC was superior to apnoeic oxygenation technique in maintaining oxygenation status in patients undergoing rigid bronchoscopy for FB removal.

Nursing Activities in the Prevention and Treatment of Perioperative Complications After Airway Foreign Body Removal in Pediatric Patients.

1) To evaluate postanesthesia complications after bronchoscopy performed for a suspected foreign body (FB) in the pediatric population and 2) To propose an algorithm of nursing activities for management of this problem. A retrospective descriptive design was used. A chart review of 155 children who underwent rigid bronchoscopy for FB removal was conducted. Complications occurred in 78% of children: 43% of them experienced desaturation below 90% requiring oxygen therapy. Therapy ranged from oxygen administration via blow-by nasal cannula or face mask (89%) to positive pressure ventilation via bag-mask (23%). Seven percent of the population required intubation and admission to intensive care unit (all were less than 2 years of age). Our results suggest special attention to the children less than 2 years of age as serious respiratory failure may occur after FB removal. The algorithm for nurses was created to manage children after bronchoscopy.

Dexmedetomidine vs remifentanil intravenous anaesthesia and spontaneous ventilation for airway foreign body removal in children

To compare the safety and efficacy of dexmedetomidine/propofol (DP)-total i.v. anaesthesia (TIVA) vs remifentanil/propofol (RP)-TIVA, both with spontaneous breathing, during airway foreign body (FB) removal in children. Seventy-seven children undergoing rigid bronchoscopy for FB removal were randomly allocated to receive either RP-TIVA and spontaneous ventilation (Group RP, n=38) or DP-TIVA and spontaneous ventilation (Group DP, n=39). Heart rate, arterial pressure, pulse oxygen saturation (Sp(O2)), respiratory rate, end-tidal CO2 (E'(CO2)), and induction time were recorded. Adverse events, the intervention for these events, and postoperative care duration were also assessed. The mean induction times were comparable between the two groups (Group RP 12.2 min vs Group DP 13.1 min, P>0.05). At the end of the procedure, the mean (E'(CO2)) was higher in Group RP (Group RP 6.8 kPa vs Group DP 5.8 kPa, P<0.001), and respiratory rate was lower in Group RP (Group RP 20.4 vs Group DP 35.8, P<0.001). Additionally, the perioperative haemodynamic profile was more stable in Group DP than that in Group RP. The incidence rate of breath-holding and intervention were comparable between the two groups. In the post-anaesthesia care unit (PACU), no hypoxaemia was observed, and emergence time increased in Group DP (Group DP 65.1 min vs Group RP 23.8 min, P<0.0001). The incidence of cough in PACU was higher in Group RP (Group RP 55.3% vs Group DP 10.3%, P<0.0001). Compared with RP-TIVA, DP-TIVA provided more stable respiratory and haemodynamic profiles, but required a longer recovery time. Clinical trial registration China Clinical Research Information Service, ChiCTR-TRC-13003018.

Airway Foreign Body in Children

Introduction: Foreign body aspiration is not uncommon in children. It can be associated with significant morbidity and mortality. This study aims to determine and analyze the characteristics of local pediatrics airway foreign body (FB) aspiration. Methods: A retrospective study of medical records from KK hospital (1997-2010) is done. Patient demographics, clinical/investigative findings, duration of hospitalization and complications are analyzed. Results: The sample consisted of 26 patients (eight months - 13 years of age), who underwent rigid bronchoscopy for FB removal over the last 13 years. Seventy-seven percent were three years of age or younger. Peak incidence (61.6%) was at one to two years of age. Nineteen were males and seven were females. The top three clinical presentations were: cough (61.5%), choking (46.2%) and wheezing (42.3%). Decreased air entry (34.6%), tachypnea (26.9%) and no significant findings (23.1%) were the most common features on physical examination. The most common radiographic findings were consolidation (30.8%), presence of a foreign body (23.1%) and no abnormality (23.1%). Aspiration was primarily into the right main bronchus (38.5%), and 61.5% of the FB was organic in nature [principally peanuts (38.5%)]. Mean hospitalization duration was three days. Delayed diagnose in three cases were secondary to mis-diagnoses as croup (n = two) and respiratory tract infection (n = one). Complications were noted in eight cases (30.8%). There was no mortality. Conclusion: High index of suspicion is required in diagnosing airway FB. Physician’s diagnostic acumen is vital in prompt successful treatment. Heightening public’s awareness is the key to prevention of pediatrics FB aspiration.

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

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