Bronchoscopic removal of tracheobroncheal foreign bodies: value of patient history and timing

Abstract

Between 1990 and 1999, 741 bronchoscopic procedures were performed in 698 children, 594 of whom were evaluated for foreign-body aspiration (FBA) (mean age 3.9 years, male:female 287/307). Based on the presenting symptoms, clinical outcome, and complications, two major groups were identified. Group 1 consisted of 438 patients with a definitive history of FBA. Most were admitted soon after the aspiration with sudden onset of symptoms such as coughing, choking, wheezing, and respiratory distress. Group 2 comprised 156 patients with chronic pulmonary infections and/or atelectasis without a definitive history of FBA. The most common radiographic finding was emphysema of one lung in group 1 (61.1%) and pneumonia in group 2 (70%). Among the patients in whom a FB was removed, the percentage of normal radiography was 17%. The FB was identified and removed in 83% of cases in group 1. The complication rate in this group was 9.8%, and all the complications were treated medically. Only 2 patients required intercostal drainage. In group 2, a FB was identified in 25% of bronchoscopic examinations and 17% of the patients developed complications. One of these patients underwent an urgent thoracotomy due to bilateral tension pneumothoraces and 2 required tracheostomies. Patients with a definitive history of FBA, even with a normal physical examination and radiographic findings, must undergo bronchoscopic investigation. Cases with late presentation and chronic pulmonary infection are at high risk. In this group care should be take in determining the indication and timing of bronchoscopy in order to prevent life-threatening complications.

Aspiração de corpo estranho por menores de 15 anos: experiência de um centro de referência do Brasil

“…(20) Likewise, the predominance of male patients can be explained by the fact that boys are typically more curious and adventurous. (7) The principal signs and symptoms observed (dyspnea, cough and diffuse crackles) are in accordance with findings in the literature (1,3,18) and can be explained by the long time elapsed between the FBA episode and the endoscopy, such a delay typically being described as responsible for the increase of morbidity and as a risk factor for treatment failure.…”

“…(1,2) Occurring principally in the three first months of life, FBA is influenced by socioeconomic, cultural and educational factors, which determine the frequency and particularities of the foreign body aspirated. (3)(4)(5)(6) The most common complications include inflammation, laryngospasm, chronic bronchitis and pneumonia. (7) Serious complications, such as severe airway obstruction and death, tend to occur in young children due to the small caliber of their airways.…”

Tracheo-Bronchial Foreign Body Aspiration in Children: A One Year Descriptive Study

“…Emir et al [10], concluded in their study that cases with chronic pulmonary infection and late presentation are at higher risk of developing complications and care should be taken in deciding the timing of bronchoscopy in this group to avoid life threatening complications. The ventilating rigid bronchoscopy under general anaesthesia remains the gold standard for the safe removal of tracheobronchial foreign body.…”

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“…Aspiration of foreign body has a significant morbidity rate and can cause mortality in about 7% of cases [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Although there have been significant advances in pediatric endoscopic airway management, the occurrence of FBA has not changed significantly [3].The increased risk of aspiration in children during the first three years of life is attributed to many factors including: inadequately developed posterior dentition, immature neuromuscular mechanisms of both deglutition and airway protection, and the ubiquitous tendency of children below 3 years of age to put objects into their mouths [22].…”