Tracheobronchial Foreign Body Research Articles

Distribution and drug resistance of the pathogenic bacteria from sputum specimens of 1 125 children with tracheo bronchial foreign bodies

To analyze the distribution and drug susceptibility of the pathogenic bacteria in the airway secretions in children with tracheobronchial foreign bodies so as to assist physicians in clinical prescription. Sputum specimens of 1 125 children with tracheobronchial foreign bodies were collected in removal of the foreign bodies by rigid bronchoscope, and the drug susceptibility test was performed. Pathogenic bacteria were detected in 218 (19.4%) of 1 125 sputum specimens. Among the pathogenic bacteria, 126 (57.79%) strains were gram-negative bacilli, consisting of 76 (34.86%) strains of Haemophilus influenzae, 10 (4.59%) strains of Escherichia coli, 7 (3.21%) strains of Sewer enterobacter, 7 (3.21%) strains of Pseudomonas aeruginosa, and 6 (2.75%) strains of Klebsiella bacillus; and 92 (42.21%) strains were gram-positive bacilli, consisting of 80 (36.69%) strains of Streptococcus pneumonia and 10 (4.59%) strains of Escherichia coli. Most of detected gram-negative bacilli were highly sensitive to cefepime, ceftazidine, imipenem and amikacin, no strains were resistant to meropenem and ciprofloxacin. None of the detected gram-positive bacilli were resistant to cefepime, vancomycin, levofloxacin and teicoplanin. The Haemophilus influenzae of gram-negative bacilli and the Streptococcus pneumonia of gram-positive bacilli are the main pathogenic bacteria existing in the airway secretions of children with tracheobronchial foreign bodies. The Haemophilus influenzae were highly sensitive to cephalosporin, imipenem and amikacin, and the Streptococcus pneumonia to cefepime, vancomycin, levofloxacin and teicoplanin.

Headscarf Pin Localized in the Right Main Bronchus and Two Pins in the Abdomen

Tracheobronchial foreign body aspiration is a serious condition that might result in mortality and it necessitates emergency intervention. Studies in literature report cases of pin aspiration related to headscarf use in Muslim countries. The most frequent symptom in foreign body aspirations is coughing. Radio-opaque foreign bodies can be detected through lung radiology. Following diagnosis, the foreign body needs to be removed as soon as possible. The removal procedure is carried out by flexible fiberoptic bronchoscopy or rigid bronchoscope. We hereby present the case of a patient who presented to the emergency department with headscarf pin aspiration and whose radiography results revealed 2 pins in the abdomen and one pin in the right main bronchus.

Tracheobronchial Metallic Foreign Body Aspiration in an African Child during Magic Game

A significant proportion of cases of tracheobronchial foreign body aspiration due to life-threatening condition is observed during childhood and still one of the most common pediatric emergencies. We report the case of a 4 year-old male child who aspirated a shaped metallic foreign body placed in his mouth while playing magic in school, highlighting prevention via parental education and avoidance of objects that produce the greatest risk with children. The clinical presentation was cough, sputum and chest pain which was relieved almost instantly after aspiration. Early diagnosis and treatment with rigid bronchoscopy under general anesthesia should be performed by experienced personnel in patients suspected of foreign body aspiration to avoid life threatening respiratory sequelae. There is a need of exercise caution by parents in the handling of their children.

Tracheobronchial Metallic Foreign Body Spontaneous Inhalation in a Child during Magic Game

A significant proportion of cases of tracheobronchial foreign body aspiration due to life-threatening condition is observed during childhood and still one of the most common pediatric emergencies. We report the case of a 4 year-old male child who aspirated a shaped metallic foreign body placed in his mouth while playing magic in school, highlighting prevention via parental education and avoidance of objects that produce the greatest risk with children. The clinical presentation was cough, sputum and chest pain which was relieved almost instantly after aspiration. Early diagnosis and treatment with rigid bronchoscopy under general anesthesia should be performed by experienced personnel in patients suspected of foreign body aspiration to avoid life threatening respiratory sequelae. There is a need of exercise caution by parents in the handling of their children.

Bronchoscopy in the diagnosis and removal of tracheobronchial foreign bodies

Bronchoscopy in the diagnosis and removal of tracheobronchial foreign bodies

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.

Bronchial lavage and chest percussions relieved complete airway obstruction due to crushed foreign body: A case report

Tracheobronchial foreign body (FB) is always a clinical challenge. Dropping the FB during retrieval is a potentially life-threatening complication, which, if not promptly diagnosed and treated, can prove fatal. We present a case of complete airway obstruction due to crushed and slipped FB during its retrieval from the upper airway. Its tiny fragments dropped down and obstructed the lower bronchial trees. This is a very rare potentially lethal event, which was successfully managed with concomitant bronchial lavage and chest percussion.

An Unusual Case of Tracheobronchial Foreign Body Aspiration in a Laryngectomized Patient: Rolled Tissue

Abstract Tracheobronchial foreign body aspirations are the most common cause of acute respiratory obstruction and vital health problem that have to be diagnosed and managed immediately. Aspiration can lead to serious consequences up to respiratory arrest, if complete or near complete airway obstruction occurs or intervention is delayed. The existence of tracheal stoma after previous surgeries is an important factor that facilitates foreign body aspiration. In this article we present a case with total laryngectomy who aspirated roll of tissue when he tried to clean tracheal stoma. It is very important to keep in mind the possibility of foreign body aspiration through stoma in tracheotomized patients presented with respiratory compromise. Immediate diagnosis and proper intervention of this situation is life-saving. Keywords: Tracheal stoma, foreign body, aspiration

Aerodigestive tract foreign bodies: an experience at a teritiary-care hospital

Background: Foreign bodies (FBs) in aerodigestive tract are a common concern for all ENT surgeons and chest physicians. While FBs in air passage are commonly seen in younger children, FB in food passage is encountered in children and adults alike. Foreign body is ingested accidentally but occasionally homicidal or suicidal. This study is about the experience of aerodigestive FBs at a tertiary-care hospital. Objective: To reveal our experience of aerodigestive FBs in terms of (i) age/sex distribution of aerodigestive FBs; (ii) site of impaction/nature of aerodigestive foreign bodies; and (iii) different procedures done for aerodigestive foreign bodies. Materials and Methods: This is a retrospective study done in the Department of ENT and Head and Neck surgery and Department of Chest Medicine In this study, ENT operation theatre registers and registers of bronchoscopy laboratory of chest medicine were analyzed for all the data about removal of aerodigestive FBs from April 2007 to March 2014. Result: This study includes a total of 1125 foreign bodies, of which 878 were in digestive tract and 247 in respiratory tract. Bone chip was the commonest foreign body ingested, whereas whistle and seed were the commonest FBs inhaled. Conclusion: FBs in an airway is an acute emergency. The general physician should know when to suspect an aerodigestive FB and should refer such cases as soon as possible to tertiary centers for removal. Rigid bronchoscopy, especially, and flexible bronchoscopy in few selected cases are the treatments of choice for tracheobronchial FBs. Cricopharynx is the most common site of FB lodgment in the digestive tract. Right main bronchus is the commonest site of lodgment of inhaled FB. Seed of dry fruits is the commonest FB inhaled.

English

Accidental foreign body aspiration represents a common problem in India, especially in the pediatric population. The main challenges facing an otolaryngologist in rural tertiary care Centre's of developing countries include the significant delays in referral, the relative lack of sophisticated equipment at the surgeons' disposal and the mortality associated with loss of airway. MATERIALS AND METHODS: All patients who underwent bronchoscopy for suspected aspiration of foreign bodies in North Bengal Medical College, Darjeeling, between June, 2012 and May, 2014 were included in the study. All patients underwent rigid bronchoscopy under general anesthesia. Foreign bodies, when found, were removed using conventional grasping forceps. RESULTS: Thirty-six patients were admitted for suspected tracheobronchial foreign body (TFB) during the study period. The presentation pattern was highly variable between the patients although the predominant presenting complaint was that of respiratory distress (63.9%). The interval between suspected accidental inhalation and presentation ranged from 1 to 31 days. The foreign bodies retrieved were classified into four broad groups. Seeds and nuts were the most common foreign body. The site of lodgment of the foreign body in the tracheobronchial tree was also variable. CONCLUSION: Our experience in a rural tertiary care centre in West Bengal has shown that a high index of suspicion must be present to diagnose such cases as early as possible. Digital radiographs might be normal in a considerable number of cases and any suspicion of a TFB should warrant a bronchoscopic examination. Symptoms like choking and cough may not be always present and even a definite history of accidental foreign body aspiration may be absent.

Different anesthesia research in pediatric foreign bodies via fiberoptic bronchoscopy

Objective To investigate the clinical effect of two different anaesthesia methods in removing the tracheobronchial foreign bodies in children. Methods This was a retrospective study with 56 hospitalized children through fiberoptic bronchoscope foreign body removing since September 2010 to July 2013 in Gansu Provincial Maternity and Child-Care Hospital. All of the children whose age from 8 months to 11 years were diagnosed of tracheal-bronchial foreign body. Among 56 cases, 30 cases were operated with deep sedation anesthesia (deep sedation anesthesia group), and 26 cases with general anesthesia (general anesthesia group). The clinical effect of the two kinds of anesthesia were compared. Results The success rate of foreign bodies in deep sedation anesthesia group and general anesthesia group were 83.33% and 96.15% respectively (P>0.05), there were no statistical differences in oxygen desaturation (86.67% vs 92.31%), cyanosis (30.00% vs 26.92%), bleeding (16.67% vs 15.38%), fever (6.67% vs 3.85%), voice hoarse (40.00% vs 34.62%), vomiting (26.67% vs 19.23%), and other complications between two groups (P>0.05, respectively). There were significant differences in the rate of choking cough (11.54% vs 93.33%) and resistance (0 vs 73.33%) between general anesthesia group and deep sedation anesthesia group (P 0.05). Conclusion Compared with the deep sedation anesthesia, the success rate of removal foreign bodies is higher, and the removal foreign body time as well as comfort are all significantly improved through general anesthesia, but the average hospitalization cost and average preparation time of general anesthesia are bigger than those of deep sedation anesthesia. Key words: Bronchoscopy; Children; Tracheobronchial foreign body; Anesthesia

Tracheobronchial Foreign Bodies in Children: Imaging Assessment

Tracheobronchial foreign-body aspiration is a relatively frequent pediatric emergency and a cause of substantial morbidity and mortality especially in preschool children. Although foreign-body aspiration may cause sudden airway obstruction and subsequent death, quite often symptoms are mild and nonspecific; therefore, the correct diagnosis may be delayed particularly in the pediatric population. A delay in diagnosis increases the rate of complications and can cause substantial morbidity. Early and accurate diagnosis combined with intervention through foreign-body retrieval is critical for proper patient management. For evaluation of both radiopaque and non-radiopaque airway foreign bodies in pediatric patients, imaging plays an important role in initial detection and follow-up evaluation. In this article, we discuss the currently available imaging modalities and techniques for evaluating tracheobronchial foreign bodies in infants and children. Imaging findings of various tracheobronchial foreign bodies and mimics of foreign bodies are also discussed. In addition, information regarding management of tracheobronchial foreign-body aspiration is included.

A retrospective study of anesthesia during rigid bronchoscopy for airway foreign body removal in children: propofol and sevoflurane with spontaneous ventilation

Tracheobronchial foreign body aspiration is a significant cause of childhood morbidity and mortality. We analyzed our experience in management of aspirated foreign bodies, including methods of anesthesia used, over a 4-year period. We retrospectively reviewed the records of tracheobronchial foreign body removal by rigid bronchoscopy with spontaneous ventilation in 435 children. All patients had received initial anesthesia with inhaled sevoflurane. One hundred and ninety-seven patients (Group PropRemi) then received intravenous propofol and remifentanyl for maintenance of anesthesia; the remaining 238 patients (Group PropSevo) received propofol and sevoflurane. Tracheobronchial foreign body was found in 405 children (93.1%) and successfully removed from 402 (99.3%) children. Among three patients who failed bronchoscopy, one child suffered cardiac arrest and died during the bronchoscopy, and two required subsequent tracheotomy for foreign body removal. Adverse effects (intraoperative coughing, breath holding, body movement, bronchospasm, and laryngospasm) were significantly more frequent in Group PropRemi than in Group PropSevo. No complications such as bleeding, pneumothorax, pneumomediastinum, or the need for thoracotomy were encountered. Sevoflurane induction followed by a combination of sevoflurane and continuous infusion of propofol resulted in fewer adverse events than sevoflurane induction followed by TIVA with propofol and remifentanyl during rigid bronchoscopy for airway foreign body removal in children with spontaneous ventilation.

Fractured and migrated tracheostomy tube in the tracheobronchial tree

ObjectiveTo study the clinical presentation and management of fractured tracheostomy tube (FTT) presenting as tracheobronchial foreign body (FB) in children. MethodsA retrospective chart review of children with a diagnosis of FTT, FB in tracheobronchial tree was carried out. Data regarding the patients’ demographic details, diagnosis, clinical presentation and management were noted and analyzed. ResultsTotal 8 cases (males 3 and females 5, average age 8.8 years, range 1–15 years) wearing tracheostomy tube for an average period of 2 years (range 3 months–4 years) were found. Indications for tracheostomy were bilateral abductor palsy, subglottic stenosis and congenital subglottic hemangioma in 4 (50%), 3 (37.5%) and 1 (12.5%) cases, respectively. Classical triad of FB aspiration (coughing/choking, wheezing and reduced breath sounds) was present in 6 (75%) patients.Aspirated FTTs were Jackson’s metallic inner tube, Romson’s polyvinyl chloride plastic tube and Fuller’s outer tube flange in 4 (50%), 3 (37.5%) and 1 (12.5%) respectively. The most common fracture site was at the junction between tube and neck plates {in 7 (87.5%) children}. Sites of lodgment of FTT were right bronchus, trachea and both trachea and left bronchus in 5 (62.5%), 2 (25%) and 1 (12.5%) cases, respectively.FTTs were retrieved by transtracheostomal rigid bronchoscopy and exploring the tracheostomal wound in 7 cases and 1 case, respectively. ConclusionThough FTT presenting as pediatric tracheobronchial FB is rare, it should be considered in differential diagnosis in a tracheostomised child with respiratory distress. When diagnosed, FTT removal is best done using a rigid bronchoscope through the tracheal stoma.

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.

Aerodigestive foreign bodies in adult ethiopian patients: a prospective study at tikur anbessa hospital, ethiopia.

Introduction. Foreign bodies (FBs) in the aerodigestive tract are important causes of morbidity and mortality and pose diagnostic and therapeutic challenges. The best method of removal of an esophageal and tracheobronchial FB is endoscopic guided extraction. Objective. To present our experience of the removal of aerodigestive FBs in adult Ethiopian patients using rigid endoscopes. Methods. A hospital-based prospective study, at Tikur Anbessa Referral and Teaching Hospital, from January 2011 to December 2012 (over two years). Results. A total of 32 patients (18 males and 14 females) with a mean age of 28.0 ± 12.74 years were treated for FB ingestion and aspiration at Tikur Anbessa Hospital. The FBs were impacted at the esophagus in 18 (56.2%) patients, at the pharynx in 7 (21.8%), and at the air way in 7 (21.8%) patients. Pieces of bones were the commonest objects found in the esophagus (17/18 of the cases) and the pharynx (4/7), while fractured tracheostomy tubes and needles were frequently seen in the air way (3/7 cases each). The foreign bodies were visible in plain radiographs of 26 (81.2%) patients. Successful extraction of FBs was achieved by using Mc gill forceps in 11 cases, rigid esophagoscopes in 9 patients, and bronchoscopes in 4 cases. Four cases required open surgery to remove the foreign bodies. Two complications (one pneumothorax and one esophageal perforation) occurred. All patients were discharged cured. Discussion and Recommendations. Aerodigestive FBs are not so rare in the hospital and timely diagnosis and removal of accidentally ingested and aspirated foreign body should be performed so as to avoid the potentially lethal complications associated. Rigid esophagoscopy requires general anesthesia and is associated with its own complications, but our experience and outcome of its use are encouraging.

A foreign body which caused esophageal perforation and was aspirated into the right main bronchus

Tracheobronchial and esophageal foreign body aspirations are life-threatening, and require immediate intervention. Major symptoms in case of a foreign body aspiration are shortness of breath, cough, wheezing and cyanosis. In esophageal foreign bodies, the major symptoms caused by irritation are dysphagia, hypersalivation and odynophagia. Foreign bodies lodged in the cervical esophagus and hypopharynx can cause airway obstructions by moving into the adjacent organs with the effect of coughing, swallowing or esophageal peristalsis. In this study, a patient who swallowed a chicken bone which caused a perforation in the proximal esophagus and then aspirated the bone into the right main bronchus is presented. J. Exp. Clin. Med., 2014; 31:193-195

Tracheobronchial foreign body aspiration: A 13-year retrospective analysis

Introduction. Foreign body aspiration into the respiratory tract remains a diagnostic and therapeutic challenge in clinical practice, especially in young children, who are the most frequently affected age group. The aim of this study was to present the results of treating the patients with foreign body aspiration in all age groups. Material and Methods. The medical and radiological records of 64 patients with confirmed foreign body out of 146 patients with suspected foreign body aspiration were retrospectively analyzed during the period of 13 years (from 2001 to 2013). Results. A foreign body was found in 64 (44%) of the 146 patients of all age groups with suspected foreign body aspiration. The patients? age ranged between 11 months and 80 years. There were 84% children and 16% adults, and 63% of patients were male. Time between the moment of aspiration and admission to the Department ranged between 0.5 hours and 14 days, with majority of patients (70%) being admitted during the first 24 hour. History of respiratory drama was present in 92% of patients. Physical and radiological findings were positive in 66% and 47% of patients, rescpectively. Organic vegetable foreign bodies accounted for 75% of all cases, and they were most frequently found in the right main bronchus (63%). All foreign bodies were successfully extracted by rigid bronchoscopy, without serious complications and fatal outcomes. Conclusion. Bronchoscopy should be performed in any case of suspected foreign body aspiration, even if clinical and radiological findings are normal, in order to avoid serious and possible life-threatening complications. More should be done to raise awareness of this potentially preventable condition.

Tracheobronchial foreign body aspiration in children: A continuing diagnostic challenge.

Foreign body aspiration (FBA) is a common cause of respiratory compromise in early childhood. The objective of this study was to describe the features and outcomes of children with FBA in early and late presentations and to examine the reasons for the delay in diagnosis. This is a retrospective review of all children who were admitted with suspected FBA between July 2001 and June 2010. Patient's characteristics, history, clinical, radiographic, bronchoscopic findings, reason for delay presentation, and complications were noted. A total of 158 children admitted to the hospital with suspected FBA were included in this study. The average age was 3.28 years. Forty-eight (30.3%) children were presented late (more than 14 days after FBA) and 110 (69.7%) children were presented early (0-14 days). The common clinical manifestations of FBA were persistent cough (100%) and choking (72%). The most frequent radiological finding observed was air trapping (40%) followed by atelectasis (14%). Chest radiographs were normal in 32.2% patients. Ten children in early diagnosis group and 29 children in late diagnosis group presented with complications. The diagnosis delay was mainly attributed to physician misdiagnosis (41.6%). Rigid bronchoscopy was performed in all patients. Foreign body was found in all of the cases except six. Watermelon seeds and peanuts accounted for 80% of the aspiration. FBA is difficult to diagnose in children. Delay in diagnosis appears to result from a failure to give serious consideration to the diagnosis. Early diagnosis and removal of foreign bodies must be achieved to avoid complications.

Tracheobronchial Foreign Body Aspiration in Children

Tracheobronchial Foreign Body Aspiration in Children