Tracheobronchial Foreign Body Research Articles

Tracheobronchial Foreign Body in Children with an Insidious Medical History.

This study explored the clinical features of tracheobronchial foreign bodies (TFB) in children lacking both a foreign body aspiration history and bronchial cut-off signs on imaging. This study was conducted between 2011 and 2021, including 45 children without a choking history or tracheal interruption on CT scans. Common symptoms were cough and wheezing (91.1%, 41 cases), followed by decreased breath sounds (55.6%, 25 cases), rales (48.9%, 22 cases), and wheezing (42.2%, 19 cases). Prior to TFB confirmation, bronchopneumonia was the prevalent diagnosis (88.9%, 40 cases). Vegetable matter was the most frequent foreign body type (75.6%, 34 cases), primarily located in the right main bronchus (31.1%) and left lower lobe bronchus (22.2%). TFB in children with obscure medical histories presents non-specifically, highlighting bronchoscopy's pivotal role in diagnosis and treatment. Key Words: Bronchoscope, Paediatrics, Tracheobronchial foreign body, Diagnosis.

Clinical characteristics and removal approaches of tracheal and bronchial foreign bodies in elders

The symptoms of tracheobronchial foreign body in the elderly are not typical, so they are often missed or misdiagnosed. This study aims to depict the clinical characteristics of tracheobronchial foreign body inhalation in the elderly. We retrospectively analysed the clinical data of elder patients (age ≥ 65 years) diagnosed with tracheal and bronchial foreign bodies. The data included age, sex, clinical symptoms, type and location of foreign bodies, prehospital duration, Chest CT, bronchoscopic findings, and frequencies and tools for removing these elderly patients' tracheal and bronchial foreign bodies. All patients were followed up for a half year. Fifty-nine cases were included, of which only 32.2% had a definite aspiration history. Disease duration > 30 days accounted for 27.1% of the patients. 27.1% of the patients had a history of stroke, and 23.8% had Alzheimer's Disease. Regarding clinical symptoms, patients mainly experience cough and expectoration. The most common CT findings were abnormal density shadow (37.3%) and pulmonary infiltration (22.0%). Under bronchoscopy, purulent secretions were observed in 52.5% of patients, and granulation tissue hyperplasia was observed in 45.8%. Food (55.9%) was the most common foreign object, including seafood shells (5.1%), bones (20.3%), dentures (18.6%), and tablets (20.3%). The success rate of foreign body removal under a bronchoscope was 96.7%, 28.8% of the foreign bodies were on the left and 69.5% on the right. 5.1% of the elderly patients required rigid bronchoscopy, and 6.8% required two bronchoscopies. In elderly cohorts, tracheal foreign bodies are obscured by nonspecific clinical presentations and a paucity of aspiration history, challenging timely diagnosis. Predominantly constituted by food particles, with a notable predilection for the left bronchial tree, these cases demand skilled bronchoscopic management, occasionally requiring sophisticated approaches for successful extraction.

Unusual Tracheobronchial Foreign Bodies: Clinical Presentation and Management in Adults

Unusual Tracheobronchial Foreign Bodies: Clinical Presentation and Management in Adults

Three different surgical methods of the special tracheobronchial foreign body (pen cap) in children: Case series

We present three novel cases of tracheobronchial foreign bodies (TFBs) in children caused by pen caps. One was removed by the rigid bronchoscopy successfully, the second was removed by rigid bronchoscopy combined with tracheotomy, and the last one was treated by bronchotomy from an external thoracic approach. Rigid bronchoscopy is the most widely used for treating TFBs in clinics, especially treating large and special foreign bodies, because rigid bronchoscopy can provide a good view for observation and operation. Successful removal of a foreign body under rigid bronchoscopy (an experienced doctor, suitable instruments, etc.) can obviate tracheotomy/tracheostomy or thoracotomy/bronchotomy.

Unusual Intra-Bronchial Foreign Body: About a Case Report

Tracheobronchial foreign bodies Inhalation is a frequent reason for consultation in pediatrics, but rarely seen in adults. We report the case of a 40-year-old woman, without any particular pathological history, presented for a blood- streaked purulent sputum, right subclavicular tingling chest pain and dyspnea on exertion among two days following accidental inhalation of a turkey bone. The clinical examination and the chest X-ray were normal, the chest CT scan showed a calcifield foreign body in the right lower lobar bronchus. Flexible bronchoscopy allowed an extraction of the turkey bone without complications, which was located in the initial part of the intermediate bronchus. The evolution was marked by a complete recovery. Foreign body inhalation is a real emergency and its management must be fast, based on delicate extraction by endoscopy to avoid complications.

Pediatric anesthetic for tracheobronchial foreign body extraction: A survey of practice in France.

Tracheobronchial foreign body aspiration is a classic pediatric emergency, and its associated morbidity particularly depends on the anesthetic management, which differs according to the center and the practitioner. The aim of this study was to evaluate the different anesthetic practices for tracheobronchial foreign body extraction. A survey was sent via email to the member physicians of the Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF). The survey included 28 questions about the organizational and anesthetic management of an evolving clinical case. A total of 151 physicians responded to the survey. Only 13.2% of the respondents reported that their institution had a management protocol, and 21.7% required a computerized tomography scan before the procedure was performed for children who were asymptomatic or mildly symptomatic during the night. There were 56.3% of the respondents who reported that extraction with a rigid bronchoscope is the only procedure usually performed in their institution. Regarding rigid bronchoscopy, 47.0% used combined intravenous-inhalation anesthesia. The objective was to maintain the child on spontaneous ventilation for 63.6% of the respondents, but anesthesia management differed according to the physician's experience. Our study confirms the diversity of practices concerning anesthetic for tracheobronchial foreign body extraction and found reveal differences in practice according to physician experience.

Risk factors for difficult removal of tracheobronchial foreign bodies in children by rigid bronchoscopy.

To characterize the risk factors for difficult removal of tracheobronchial foreign body (FB) by rigid bronchoscopy in children. We retrospectively analyzed clinical data of 1026 pediatric patients (age: 0-18 years) diagnosed with tracheobronchial FB between September 2018 and August 2021. All patients underwent rigid bronchoscopy as the first intervention at our hospital. Children aged 1-3 years accounted for 83.7% cases in our cohort. The most common symptoms were cough and wheeze. FBs were more frequently found in the right bronchus, and trachea FBs accounted for only 8.19% cases. The success rate of rigid bronchoscopy in a single attempt was 97.27%. 12.18% of the cases were defined as difficult removal of FB. On univariate analysis, age, CT findings (pneumonia), type of FB, diameter of FB, FB location, granulation tissue formation, and the seniority of the surgeon were identified as risk factors for difficult removal of tracheobronchial FBs. On multivariate analysis, age ≥3 years, FB diameter ≥10mm, FBs located in left bronchus, multiple FBs, granulation tissue, and the seniority of surgeon (<3 years, ≥5 years) were independent risk factors for difficult removal. Age, FB diameter, location of FB, granulation tissue formation, and the seniority of the surgeon were risk factors for difficult removal of FBs by rigid bronchoscopy.

A RETROSPECTIVE STUDY ON EVOLVING TRENDS IN LOWER AIRWAY FOREIGN BODIES IN INDIAN CHILDREN AT A TERTIARY CARE HOSPITAL

Introduction Foreign body (FB) in the pediatric airway is a prevailing and crucial emergency with presenting symptoms often overlapping with other common pediatric conditions.[ ] The best way to manage it is an early diagnosis and a rigid bronchoscopy removal under general anesthesia used by fully trained staff . Lack of proper health education, superstitions, negligence from parents side and lack of availability of timely and expert medical help results in delayed or inadequate management. . A foreign body aspiration into the respiratory tract is a serious condition of the respiratory [2 ] system, characterised by a variability of medical history, symptoms and prognosis. Methodology This study was a retrospective conducted from Jan 2018 to Dec 2022.We selected a series of 50 patients under the age of 5 yrs conducted in the Department of ENT of M.G.M Medical College and M.Y.Hospital Indore(MP). Discussion In our study highest incidence of FB was seen in the children between the age group of 1-3years which is more common because toddlers of this age group are prone to put anything coming in their hands in mouth as they explore the world. This is clearly evident in our study that the incidence of FB is more in rural areas. Tracheobronchial metallic foreign bodies early detection and removal is necessary to avoid life threatening respiratory complication. Foreign body aspiration is Conclusion a common but largely preventable problem and every case of a respiratory distress should be suspected for foreign body. Rigid Bronchoscopy is the gold standard for the diagnosis and the most safe treatment method for foreign body removal. Use of optical forceps is advantages not only for foreign body removal but also for educational, teaching, learning, record keeping &amp; medicolegal purpose also.

Correlative Factors for Types of Tracheobronchial Foreign Bodies Encountered in Children.

To characterize the correlative factors for types of tracheobronchial foreign bodies (TFBs) encountered in children. All included patients diagnosed with TFB underwent rigid bronchoscopy as the first surgery in the Children's Hospital of Chongqing Medical University. The data of 1026 patients aged 0-18years were retrospectively collected between February 2019 and January 2022. About 94.44% of the children with TFB had organic FBs, among which, peanuts were the most common FBs, followed by melon seeds and walnuts. The most common inorganic FBs included pen points or caps, plastic toys, and plastic papers. As compared to the children with organic FBs, those with inorganic FBs consisted of a higher proportion of children aged ≥3years old, a time before surgery of >7days, dyspnea, FBs size of >10mm, longer operation time, more than two operation procedures, and atelectasis. On the other hand, the proportion of children with aspiration history, cough, and obstructive emphysema in the inorganic FB group was lower as compared to the organic FBs (P< .05). The related factors related to the patient's characteristics, symptoms, operation situations, and preoperative complications can be predicted based on the identification of FB type.

Foreign Body Aspiration in Children and Emergency Rigid Bronchoscopy: A Retrospective Observational Study.

Foreign body aspiration is potentially life-threatening in paediatric age group. Early recognition and emergency intervention by Rigid bronchoscopy is life-saving. To highlight various difficulties in emergency paediatric bronchoscopy and discuss our experience in 138 patients. < 12years children with suspected foreign body aspiration were included. Data of 138 patients < 12years of age were studied. The most common foreign body found was peanut and organic foreign bodies constituted of total foreign bodies removed. Choking, Cough and sudden onset breathlessness were common symptoms. Tachypnoea, asymmetric breath sound, rhonchi, stridor, reduced chest movements were common signs. Obstructive emphysema was commonest radiological findings. Majority of the patients were discharged within 72h & only two patients expired. History, clinical and radiological findings are highly indicative of foreign body in the airway. Inspite of being a high risk procedure, Rigid bronchoscopy when performed with necessary expertise,trained anaesthesia team and a paediatric ICU, saves majority of lives of children with tracheobronchial foreign bodies.

Çocuk Yaş Grubu Yabancı Cisim Aspirasyonu Tedavisinde Kullanılan Rijit Bronkoskopi Esnasında Uygulanan İki Anestezi Tekniğine Cerrahi Bir Bakış

Objective: In our study, we aimed to reveal the advantages and disadvantages of inhalation and intravenous anesthesia techniques in the maintenance of anesthesia in pediatric patients whose tracheobronchial foreign body was removed by rigid bronchoscopy under general anesthesia, from both anaesthesia and surgical perspectives, different from the literature.&#x0D; Methods: The patients were divided into two groups, each consisting of 34 individuals, whose anaesthesia was maintained with sevoflurane inhalation or propofol infusion. Demographic characteristics of the patients, symptoms at presentation, radiological examinations, anaesthesia and surgical procedures, complications were analyzed. In addition, surgical difficulty and surgical comfort scales created from the experiences of our institution were used. The results obtained and the effects of inhalation and intravenous anaesthetics used in maintenance on the duration of the procedure, clinical, hemodynamic and surgical comfort were compared.&#x0D; Results: Vital signs during the procedure were similar in both groups. was similar. The duration of bronchoscopy was statistically significantly shorter in the intravenous anaesthesia group (p=0.014), and secondarily, the duration of anaesthesia was significantly longer in the inhalation anaesthesia group (p=0.027). While the surgical difficulty scale was similar in both groups, the surgical confort scale was significantly higher in the intravenous anesthesia group (p=0.017). Intraoperative, postoperative complications were similar in both groups.&#x0D; Conclusion: Anaesthesia maintenance with sevoflurane prolongs the duration of bronchoscopy and accordingly the duration of anaesthesia, and also reduces surgical satisfaction independent of processing time. For these reasons, we think that while rigid bronchoscopy is performed for the removal of childhood foreign body aspirations, propofol can be preferred for anaesthesia maintenance, resulting in a shorter procedure time and higher surgical satisfaction.

When tracheotomy was the only resort in paediatric tracheo-bronchial foreign body: case report

The pediatric individual is likely to present with an aspirated foreign body that maybe oriented as such that it may necessitate often an alternate route for removal. Rigid bronchoscopy with jet ventilation is the intervention undertaken at the earliest. In wide caliber foreign bodies a different approach has to be adopted. Tracheotomy, thoracotomy, bronchotomy and pneumonectomy are the next level procedures. A cervical tracheostomy had to be undertaken in a child with a week old impacted conical tail cap of a ball point pen.

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.

The Transition of Pediatric Tracheobronchial Foreign Body Cases in the Past 36 Years: A Retrospective Single-Center Study in Japan.

Tracheobronchial foreign bodies (TFBs) are pediatric airway emergencies frequently seen. We aimed to examine the changes in the clinical characteristics of pediatric TFB patients in a single institution within the past 36 years. We retrospectively reviewed the data of 85 patients aged 0-10 years with TFBs lodged in the trachea or bronchus admitted at the Department of Otolaryngology-Head and Neck Surgery at Tohoku University Hospital between 1986 and 2021. We also compared the characteristics, diagnostic methods, and treatments of the previous 64 cases (1986-2005) with those of the recent 21 cases (2006-2021). The number of TFB patients decreased later in this study (3.2 vs. 1.3 patients per year). The proportion of TFB patients aged > 3 years was significantly higher in the later period (6.3% vs. 23.8%, p = 0.038). Peanut was the most common cause of TFBs in both periods, and the overall incidence of peanut aspiration significantly decreased in the later period (68.8% vs. 38.1%, p = 0.019). No patient had an undetected TFB for more than 1 month after the onset of symptoms in the later period. Foreign body extraction using rigid bronchoscopy was performed in all patients earlier, whereas flexible bronchoscopy was used in 14.3% later. Our study revealed a recent trend in the clinical characteristics of pediatric TFB patients in a single institution in Northeast Japan. The prevention and treatment of pediatric TFBs should be considered following the recent trends.

Tracheobronchial foreign body inhalation: Experience of 234 case series

Tracheobronchial foreign body inhalation: Experience of 234 case series

Anesthetic Management in a 4-Year-Old Child Undergoing Removal of a Gemstone Tracheobronchial Foreign Body.

Anesthetic Management in a 4-Year-Old Child Undergoing Removal of a Gemstone Tracheobronchial Foreign Body.

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.

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.

PEANUTS: a national survey on the management of pediatric tracheobronchial foreign bodies.

To assess the different types of management of pediatric foreign body aspirations in order to help define guidelines, depending on clinical presentation. A national survey in France was emailed to all 30 university-affiliated departments of otolaryngology-head and neck surgery and pediatric pulmonologists in France. Data concerning the center and the experience of each participant were collected in order to define an "senior expert" group with experience of extracting more than 10 foreign bodies and a "junior/non-expert" group. Both groups answered questions concerning five clinical cases of foreign body aspiration of different severities. Ninety-eight participants answered this survey (75 otolaryngologists and 23 pulmonologists), representing 28 of the 30 university-affiliated departments in France with a completion rate of 89%. Responses of the senior expert group were similar for clear-cut situations, such as an asymptomatic child with a low probability of foreign body aspiration and for a symptomatic child with respiratory distress. However, for intermediate situations, management varied significantly according to the physician when considering clinical, radiological, and surgical management. In comparison to the senior expert group, the junior non-expert group seemed more precautious in the management of foreign body aspiration for intermediate cases, in particular, concerning the time at which extraction was performed. Conclusion: The management of foreign body aspiration depends on the physician's experience and the center's habits. In order to optimize patient care for foreign body aspiration, we suggested a management algorithm based on the senior expert group responses. What is Known: •Foreign body aspirations (FBA) are dreaded by pediatricians, pediatric otolaryngologists, and pulmonologists particularly because of the potential fatal outcome. • However, consensus concerning their management is not clearly defined in the literature. What is New: •This study is the first to evaluate the management of foreign body aspirations (FBA) from the clinical assessment by the emergency medicine physician to the extraction of the foreign body. • A management algorithm was designed and secondarily validated by the SE group to help to emergency medicine physician and specialist to manage FBA.

THE ROLE OF RIGID BRONCHOSCOPY IN CHILDREN WITH TRACHEOBRONCHIAL FOREIGN BODY ASPIRATION

To assess the role of rigid bronchoscopy in children with tracheobronchial foreign body aspiration (FBA) a retrospective study was carried out in Pediatrics Ward of Bakhtawar Amin Trust Hospital &amp; Medical &amp; Dental College Multan for 1 year. A total of 80 children aged 6 months to 15 years with foreign body aspiration were included in the study. Data was collected from the medical histories of the patients. Rigid bronchoscopy was performed in all patients under anesthesia. All the data was analyzed by using SPSS version 21. The study was conducted on total 80 patients whose mean age was 2.5 years. 66 (82.5%) patients aspirated organic FBs, while 14 (17.5%) aspirated inorganic FBs. Cyanosis (37,46.2%) and stridor (33,41.2%) were the most common symptoms. In 78 (97.5%) patients rigid bronchoscopy was performed. In 75 (93.7%) not post operative event occurred. Medical history of patients with FBA is important for diagnosis. In addition, bronchoscopy is mandatory in patients with history of choking even if chest x-ray and initial examination are normal.