Tracheal Foreign Body Research Articles

Foreign Bodies in Trachea: A 25-years of Experience.

Tracheobronchial foreign body aspirations may cause cardiopulmonary arrest and sudden death. The incidence in children is higher than in adults. Rapid diagnosis and treatment is live saving. In this paper, we aimed to present our experience in tracheal foreign body aspirations and rigid bronchoscopy for 25-years. From January 1990 to January 2015, 805 patients with suspected tracheobronchial foreign body aspiration were admitted to our department. Hundred and twelve patients with tracheal foreign body were included in this study. We evaluated patients' records, retrospectively. Age, gender, clinical symptoms, physical examination findings, radiological evidences, type of foreign body and intervention types were noted. Sixty-five of the patients were female (58%) and 47 patients were male (42%), and mean age was 8.1 years (8 month-58 years). Coughing was the main symptom (n=112, 100%). Other symptoms and findings included dyspnoea and bilateral decreased lung sounds (n=73, 65.1%), bilateral rhonchi (n=68, 60.7%) and cyanosis (n=41, 36.6%). Rigid bronchoscopy was performed in all patients. The most common foreign body was nuts (n=75, 67%). The main radiologic finding was radiopaque image of the related foreign body in 27 patients (n=27, 24.1%). Cardio-pulmonary arrest occurred in 11 patients and two of them died. Tracheobronchial aspirations of foreign bodies are life-threatening events. If not diagnosed and treated rapidly, distressful results can be seen. Warning people by skilled persons on this topic will reduce the incidence of foreign body aspirations.

The Clinical Features of Tracheobronchial Living Foreign Body: Leech

SESSION TITLE: Procedures: Bronchoscopy SESSION TYPE: Original Investigation Poster PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM PURPOSE: To investigate the clinical features of tracheobronchial foreign body: leeches. METHODS: This is a retrospective study of medical records in three tertiary hospital of Yunnan Province from August 2013 to February 2015. Data was collected from patients who were diagnosed as had tracheobronchial leeches via bronchoscopy. The associated medical information, bronchoscopic features and removal method were reviewed and analyzed. RESULTS: Four patients with tracheobronchial leeches were enrolled. Among whom one-half were male and the mean age was 51.0 ± 3.5 years old (range, 48 years to 58 years). All the patients came from rural areas and had a history of drinking field unboiled water from streams, pools and springs. 3 patients had dyspnea, 1 case had cough and bloody sputum and 1 patient had mild anemia. The peripheral blood eosinophile granulocytes of 3 patients were increased. The coagulation function of all the patients was normal and all patients had no hemorrhagic tendency. Chest computed tomography showed tracheal foreign bodies of 2 cases, the basal segment of the lower lobe of the right lung had a lesion with high density in 1 case, and some exudation in the medial segment of the right middle lobe in the other case. Bronchoscopy revealed a leech in trachea of 3 cases and one leech in the right medial basal segmental bronchus of 1 case. 3 leeches were removed via cryotherapy by flexible bronchoscope and 1 leech was taken out through foreign body forceps by flexible bronchoscope. The symptoms of all the cases were improved obviously after removed the leeches. CONCLUSIONS: The physician should be aware of the possibility of the tracheobronchial leeches if the patients who come from rural areas have a history of drinking field unboiled water and have the following symptom, such as dyspnea, cough, bloody sputum and increased peripheral blood eosinophilic eosinophiles. The tracheobronchial leeches can be removed via cryotherapy or foreign body forceps by bronchoscope. CLINICAL IMPLICATIONS: The tracheobronchial leech infestation should be kept in mind especially in patients presenting with unexplained dyspnea, bloody sputum and increased peripheral blood eosinophilic eosinophiles and a history of drinking infested water from streams, pools and springs. DISCLOSURE: The following authors have nothing to disclose: Xi-Qian Xing, Zhong-Chuan Yang, Yan-Ping Li, Xu-Wei Wu, Hong-Yan Liu, Li-Qiong Liu, Li-Hui Zhang No Product/Research Disclosure Information

The application effect and safety analysis of dyclonine in children's removal of tracheal foreign body in trachea through bronchoscopy

The application effect and safety analysis of dyclonine in children's removal of tracheal foreign body in trachea through bronchoscopy

Relationship between different levels of 25- hydroxyl-vitamin D3 in serum and levels of matrix metalloprotei-nase-9 in serum and bronchoalveolar lavage fluid in children with asthma

Objective To investigate the changes and clinical significance of the levels of matrix metallopro-teinase-9(MMP-9) in the serum and bronchoalveolar lavage fluid (BALF)in children with asthma whose had different levels of 25- hydroxyl-vitamin D3[25(OH)D3] in the serum. Methods Fifty children with asthma between January 2013 and January 2015 were enrolled as the asthma group, based on the disease severity, and the patients were divided into the moderate to severe group (37 cases) and the mild group (13 cases), while 20 children with abnormal airway or tracheal foreign body were as a control group.The levels of 25 (OH) D3 and MMP-9 in the serum, levels of MMP-9 in BALF were measured and compared by using enzyme linked immunosorbent assay (ELISA)me-thod. Results The level of serum 25 (OH) D3 in the asthma group[(19.5±6.4) μg/L] was lower than that in the control group[(39.3±7.1) μg/L], and there was a statistical difference between 2 groups(P 0.05). The percentages of neutrophils, eosinophils and epithelial cells in BALF were significantly higher in different serum 25(OH)D3 levels of children with asthma than those of the control group(all P<0.05). There were significant difference levels of MMP-9 in the serum and BALF among different serum 25(OH)D3 levels of children with asthma and the control group(all P<0.05). In children with asthma, the levels of 25(OH)D3 in serum were significantly negatively correlated with the percentages of neutrophils, eosinophils and epithelial cells in BALF (r=-0.683, -0.795, -0.670, all P<0.05 ), exiting a significantly negatively correlation also seen between the serum levels of 25(OH)D3 and MMP-9 (r=-0.796, P<0.05). Conclusions Children with asthma often have low levels of serum 25-(OH)D3, 25(OH)D3 and MMP-9 may be involved in airway inflammation and airway remo-deling in children with asthma, and they may involve in the occurrence and development of asthma. Key words: Asthma; 25- hydroxyl-vitamin D3; Matrix metalloproteinase-9; Child

Application of failure mode and effect analysis in nursing care of children with tracheal foreign body removal

Objective To identify the potential risks in the process of nursing care for children with tracheal foreign body removal and improve the skills and the process, to promote the quality of nursing care and the success rate of tracheal foreign body removal. Methods The failure mode and effect analysis (FMEA) were used to analyze the potential risks in children with tracheal foreign body removal, preoperative, intraoperative and postoperative care, and to find out the possible risks in each medical treatment. For pediatric venous puncture technology was not skilled, surgical position placement inappropriate (especially in the case of foreign body removal surgery posture), surgical instruments and equipment management, intraoperative nursing cooperation and observation of the disease, postoperative transfer and other aspects of the transfer of training and improvement. Results The medical risk value (RPN) in the treatment of pediatric tracheal foreign body removal in the process of nursing in the control group was reduced from 1 284.2 to 213.2 of the experimental group. The average value of doctors' satisfaction was increased from 79.33% in the control group to 93.33% in the experimental group,P < 0.05, the difference was statistically significant. Conclusions The use of FMEA in the treatment of pediatric tracheal foreign body removal surgery care and medical risk management improve the quality of surgical care and help improve the success rate of tracheal foreign body removal. It also ensures the safety of the children in the operation process and improves the quality of nursing work. Key words: Failure mode and effect analysis; Removal of tracheal foreign bodies in children; Nursing cooperation; Quality improvement

Nail Gun Injury: An Unusual Presentation as Tracheal Foreign Body

ABSTRACT Foreign bodies in trachea usually result from accidental slippage of an oral object while external penetrating injuries arising from high velocity projectile from a nail gun are rare. Here, we report a case in which a high velocity nail from a nail gun penetrated the sternum during the nailing and benignly presented to us as a foreign body in the trachea. How to cite this article Arora N, Jain K, Malhotra V, Bansal R. Nail Gun Injury: An Unusual Presentation as Tracheal Foreign Body. Int J Otorhinolaryngol Clin 2015;7(2):57-59.

The effects of different modes of mechanical ventilation under general anesthesia on children undergoing removal of foreign body with bronchofiberscopy

Objective To explore the effects of different ventilation modes of tracheobronchial foreign body in children with fiberoptic operation under general anesthesia. Methods Sixty children (1ys≤age≤3ys) undergoing fiberoptic bronchoscopy tracheal foreign body removal according to the combinations of different ventilation modes during and after fiberoptic bronchoscopy (FOB) procedures were divided into group A [volume control ventilation (VCV) + VCV, n= 20], group B [pressure control ventilation (PCV) + VCV, n= 20] and group C (PCV + PCV, n= 20) randomly. The P mean, P max, and PetCO2 during and after fiberoptic bronchoscopy procedures were monitored. The SpO2, PaO2, and PaCO2 after mechanical ventilation 1.5 hours were recorded. Results Compared to group A, groups B and C had lower P max and P mean (P<0.05) during the FOB procedures. Compared to groups A and B, group C had a lower P max and P mean (P<0.01) after the FOB procedures. At the 1.5 hours after the procedure, all the children showed significant increase in SpO2 and PaO2 (P<0.05) and decrease in PaCO2 (P<0.05) in groups A, B, and C. Conclusions When fiberoptic bronchoscopy in tracheobronchial foreign body operation is applied in children undergoing general anesthesia, the pressure control ventilation (VCV) mode can decrease the pressure of airway (P aw) and PaCO2 than volume control mode during procedure. Key words: Anesthesia, general; Respiration, artificial; Bronchoscopy; Foreign bodies/SU; Tracheal diseases/SU

Foreign bodies in food and air passages: A clinical study

We undertook this study to evaluate the clinico-radiological profile, treatment modalities adopted and to know the relevant contributing factors. A prospective study of a hundred cases foreign bodies in food and air passages fifty each conducted over two years at a tertiary care centre. Only cases of laryngeal, tracheal, pharyngeal and upper esophageal foreign bodies are included. Radiological investigations were done as needed. A total of 100 patients were studied. The youngest was nine months of age and the eldest was 68 years. 58 (58%) were male, 42 (42%) were female. The commonest site of lodgment of FB was observed as crico pharynx (64%)and right main bronchus (48%) for food and air passages respectively. Mortality rate was observed as 2% for tracheobronchial foreign bodies while it was nil in pharyngo-esophageal. Foreign bodies in aero digestive tract constitute a common emergency in otolaryngological practice. A well planned procedure is always better and delay in diagnosis and management leads to morbid outcomes.

Two Cases of Pneumothorax and Subcutaneous Emphysema Associated with Removal of Neglected Tracheal Foreign Body

유·소아에서의 기도 이물 흡인은 일상생활에서 비교적 흔 하게 발생하지만 때로는 심각하거나 치명적인 결과를 가져올 수 있는 질환으로, 발생 초기에 정확한 진단과 적절한 치료가 요구된다. 기도 이물로 인한 증상은 무증상에서부터 호흡곤 란 및 청색증에 이르기까지 매우 다양하게 나타날 수 있고, 다 양한 증상들로 인해 기도 이물이 정확히 진단되지 못하고 천 식이나 크루프, 백일해, 폐렴 등의 다른 질환으로 오진이 될 수 도 있다. 기도 이물의 제거를 위해서는 이물의 형태나 크기, 위치, 종류, 환아의 상태 등을 종합적으로 고려하여 전신 마취 하에서 환기 기관지내시경술(ventilating bronchoscopy), 기관 절개술, 흡입술, 개흉술 등의 술식을 선택적으로 사용할 수 있 다. 기도 이물 제거 후 발생하는 피하 기종 및 기흉은 매우 드 물게 보고되고 있는 합병증으로, 기도 내에 이물이 장기간 방 치되었을 경우 이물 제거를 위한 기관기관지경술(tracheobronchoscopy)이나 기관절개술 후 발생하는 경우가 더 많은 것으 로 알려져 있다. 저자들은 최근 장기간 방치된 기도 이물을 진단 받은 환아에서 기관기관지경술 및 기관절개술을 통한 이물 제거 후 발생한 피하 기종과 기흉 2예를 경험하였기에 문 헌 고찰과 함께 이를 보고하는 바이다.

An unusual long standing tracheal foreign body – A rare incidence

Foreign body (FB) inhalation is often encountered by emergent otolaryngology services. A long standing undiagnosed FB in trachea is very rare and lethal. Inhalation of betel nut and presenting at the proximal trachea is rarer. As often in the airway FB gravitate to bronchi, long standing tracheal FB is a rare presentation and also rare in the literature. Children who are not given proper individual attention at an early age are more liable to inhale FB. FB aspiration is associated with significant morbidity.

A Case of Tracheal Foreign Body Removed by Endoscopic Approach with Tracheotomy

Foreign body (FB) airway obstruction is a life-threatening clinical situation. The FB’s are removed by bronchoscopy in the majority of patients, but in highly-selected cases, tracheotomy is occasionally indicated in foreign body extraction, when they are subglottic in location and impacted, or large enough to get obstructed at the glottic chink during endoscopic removal. Authors report one case of tracheal FB which required tracheotomy for the FB removal after the failure of FB removal with rigid bronchoscopy.

Long standing tracheal foreign body in children: A case report

Tracheal foreign body (F.B.) is uncommon and usually present with acute respiratory symptoms. We describe a 3year old child with unrecognized F.B which lodged in trachea for one year. The lodgment of F.B in the trachea in this case was considered to be of the longest duration. The case demonstrates that long standing Tracheal F.B can mimic bronchial asthma and can be a diagnostic challenge clinical features and factors participated in the delay of diagnosis is discussed.

Pneumomediastinum in cats: 45 cases (2000–2010)

To characterize the incidence, etiology, presenting complaint, clinical course, and outcome of cats with pneumomediastinum. Retrospective study from the period of January 1st, 2000 to December 31st, 2010. University teaching hospital. Forty-five cats with a radiographic diagnosis of pneumomediastinum. None. Medical and radiographic records were reviewed to identify cats with a radiographic diagnosis of pneumomediastinum. Clinical data were retrieved, including signalment, history, presenting clinical signs, diagnostic test results, treatment, complications, and survival to discharge. In 31 of 45 (69%) cats the pneumomediastinum was secondary to an obvious inciting cause. General anesthesia with endotracheal intubation and positive pressure ventilation was the most common cause in 17 of 45 (38%) cases. This was followed by trauma in 12 of 45 (27%) cats, and tracheal foreign bodies in 2 of 45 (4%) cats. Spontaneous pneumomediastinum (unknown underlying cause) was diagnosed in 14 of 45 (31%) of cases. Onset of clinical signs and diagnosis of spontaneous pneumomediastinum was preceded by emesis in 6 of 14 cats. Common presenting signs were tachypnea seen in 27 of 45 (60%) cats, increased respiratory effort in 26 of 45 (58%) cats, and subcutaneous emphysema in 30 of 45 (66%) cats. Concurrent pneumothorax was identified in 21 of 45 (47%) cats, pleural effusion in 10 of 45 (22%), and pneumoretroperitoneum in 21 of 45 (47%). The mainstay of treatment was supportive care and treatment of the underlying disease process. The prognosis for recovery was good, with 87% survival until hospital discharge. Pneumomediastinum in cats is an infrequently diagnosed condition. It is often secondary to an event such as general anesthesia with endotracheal intubation and positive pressure ventilation but less frequently may occur spontaneously. The prognosis is good with appropriate supportive care.

Tracheal Foreign Bodies

This study aimed to highlight the pitfalls of relying on radiographs in identifying potentially life-threatening upper airway foreign bodies in children. Case series. A review of the medical records of 2 cases of upper tracheal foreign body was performed. Both patients presented with biphasic stridor refractory to medical therapy and chest radiographs that were normal. One patient had a history of witnessed aspiration while the other did not. Both patients were managed by endoscopic removal of foreign bodies in the operating room and experienced no long-term sequelae related to this event. Tracheal foreign bodies present a diagnostic challenge, and patients may fail to manifest radiographic abnormalities. In patients with a characteristic history and biphasic stridor, an endoscopic evaluation of the airway should be performed to avoid potentially devastating consequences.

Diagnostic and therapeutic value of endoscopy in foreign body aspiration in children

Asphyxiation by an inhaled foreign body is a leading cause of accidental death among children younger than three years.The species of foreign body aspiration are many and varied.Immediately after inhalation the child starts to cough,wheeze,or have laboured breathing.The clinical manifestation will be different when foreign body stays in different part of bronchial tree.It's extremely easy to cause misdiagnosis.No matter whether aspiration or not,bronchoscopy should be taken.The bronchoscopy is not only the means of diagnosis,and removes the foreign body at the same time which helps to treat timely. Key words: Tracheal foreign body; Flexible bronchoscopy; Rigid bronchoscopy; Children

Comparison between tracheal foreign body and bronchial foreign body: A review of 1007 cases

ObjectiveTo determine the differences between tracheal foreign body aspiration and bronchial foreign body aspiration. MethodsThis retrospective study includes 1007 patients with the diagnosis of foreign body aspiration according to rigid bronchoscopy. Patients were divided into two groups: tracheal and bronchial foreign body groups. Age, sex, clinical presentation, pre-operative radiographic findings, rigid bronchoscopy findings, types of foreign body, and the complications of each group were observed and analyzed. ResultsOut of 989 study patients, there were 146 patients (14.5%) in the tracheal foreign body group and 843 patients (83.7%) in the bronchial foreign body group. Eighteen patients with FBs located in the larynx and presenting with multiple FBs located in the tracheal and bronchial regions were excluded from this study. The majority of the patients were under the age of three for both groups. The male to female ratio was significantly higher in the bronchial foreign body group (P<0.001). More patients in the bronchial foreign body group were misdiagnosed upon first clinical visit (P=0.001), referred from another hospital (P<0.05), or had delayed diagnosis (P<0.05). The most prominent symptom in both groups was cough, followed by decreased breath sounds, wheezing, and dyspnea. More patients in the bronchial foreign body group experienced decreased breath sounds (P<0.001), while more patients in the tracheal foreign body group experienced dyspnea (P<0.05). Chest fluoroscopy abnormalities were observed at a higher frequency in the bronchial foreign body group (P<0.001). Lateral neck X-ray results showed higher frequencies of abnormalities in the tracheal foreign body patients. Out of 30 patients in the tracheal foreign body group received a CT scan, 27 had abnormal scan results, while all 253 patients in the bronchial foreign body subgroup had abnormal results. The majority of foreign bodies were organic materials and were removed by rigid bronchoscopy at the first clinical session in 96.6% of tracheal foreign body cases and 96.0% of bronchial foreign body cases (P=0.727). Major complications, including one death, were observed only in the bronchial foreign body group. ConclusionsThe nature of tracheal foreign body aspiration is different from bronchial aspiration. Clinical presentation and pre-operative radiographic findings are helpful for diagnosis. The clinician should understand the differences between tracheal and bronchial FB cases and provide the appropriate management when either is presented.

Foreign Body Removal – Relax!

University of Virginia Medical Center, Charlottesville, Virginia. vbaum@virginia.eduTo the Editor: In the December issue, AuBuchon et al. from the Washington University School of Medicine in an Images in Clinical Medicine presentation of a high tracheal foreign body noted that “First, spontaneous ventilation is recommended.”1This same assertion is made again later in that issue in a paper from the same institution describing pediatric perioperative scenarios for use in simulation where “maintenance of spontaneous ventilation” was considered the correct response for a scenario of airway foreign body.2These two would make it seem that this is a clear requirement for caring for these children. Would any of the authors care to address several papers that have shown no advantage to spontaneous ventilation (and with a significant incidence of conversion to controlled ventilation) in a review of 94 patients;3that concluded there was no advantage to the avoidance of muscle relaxants in a series of 287 cases (inactivity with inhalational agent and muscle relaxant was “imperative”);4that found there were more problems with spontaneous ventilation than controlled ventilation with the use of muscle relaxants in a series of 384 patients;5or that concluded in a literature review of almost 13,000 patients that there is no apparent reason to avoid muscle relaxants?6

Corpo estranho traqueal em cão

The occurrence of a tracheal foreign body in a three-month-old male Poodle referred to a Teaching Veterinary Hospital due to acute coughing, gagging and nausea is reported. A bronchoscopy under general anesthesia was performed in order to obtain a diagnose. During the bronchoscopy a foreign body (maize popcorn) was observed in the intrathoracic trachea. The surgeon attempted to remove it by endoscopy, but no success was achieved. Therefore, an open procedure was performed and the foreign body removed. The patient progressed satisfactorily after the thoracotomy.

Tracheobronchial aspiration of foreign bodies and rigid bronchoscopy in children

A significant proportion of cases of tracheobronchial foreign body aspiration due to life-threatening condition is observed during childhood. The aim of the present study was to describe our experience with the diagnosis and treatment of foreign body aspirations during childhood and review published literature. One hundred and eighty-four patients under 16 years of age with a tentative diagnosis of foreign body aspiration were retrospectively evaluated according to age, sex, patient delay symptoms at presentation, foreign body type, localization and the diagnostic and therapeutic methods used. The most frequently aspirated objects were shelled nuts and seeds such as sunflower seeds, pistachio and hazelnuts. The chief symptom was cough. On physical examination, the most frequent findings were unilateral decrease of respiratory sound on the affected side with coarsening and bronchi. While 51% of cases presented a radiological finding, chest X-ray was normal in the other. All patients underwent rigid bronchoscopy under general anesthesia and a foreign body was identified in 137 (74.3%). The rigid bronchoscopy intervention was used in some cases, especially in the presence of tracheal foreign bodies of organic origin. Tracheobronchial foreign body aspiration is a significant cause of childhood morbidity and mortality. Early diagnosis and treatment is of utmost importance. Rigid bronchoscopy under general anesthesia should be performed in all patients suspected of foreign body aspiration, which could minimize mortality and morbidity if performed by experienced personnel with safe methods.

頸部食道からの陥入と考えられた気管異物症例

症例は，67歳女性。主訴は1か月前からの呼吸困難。声門下に白色病変を認め，気道の狭窄が著明であった。持参したCTでは頸部気管に腫瘤性病変を認めた。当院受診当日，緊急気管切開術を行った。気管切開孔から硬性内視鏡にて観察したところ，肉芽様病変と魚骨の異物を認めたため，摘出術を行った。術後の詳細な問診では，1年半前に，鯛を食べた直後に激しい咽頭痛が出現したが，激しい咳嗽のエピソードは認めなかった。米飯の丸呑み後に咽頭痛は軽快したため，医療機関への受診はしなかった。手術後に前医より届いた追加のCTでは頸部気管に異物ならびに異物の下端に肉芽を疑う腫瘤陰影を認めた。