Severe tracheobronchial harm due to lithium button battery aspiration: An in vitro study of the pathomechanism and injury pattern

Voelker, Johannes; Voelker, Christine; Engert, Jonas; Schendzielorz, Philipp; Hagen, Rudolf; Rak, Kristen

doi:10.1016/j.ijporl.2020.110431

Cited by 7 publications

(7 citation statements)

References 41 publications

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“…Several days later, endoscopic removal revealed an 8‐mm corroded BB in the right mainstem bronchus 44 . Recent in vitro porcine studies demonstrated tracheobronchial cartilage damage within 4 hours and significant necrosis of surrounding tissues in 12 hours, highlighting the need for prompt diagnosis and treatment 45 …”

Section: Clinical Considerationsmentioning

confidence: 99%

Current management of button battery injuries

Sethia

Gibbs

Jacobs

et al. 2021

Laryngoscope Investig Oto

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Button batteries (BB) are found in common household items and can lead to significant morbidity and mortality in the pediatric population when ingested. BBs are made of various chemistries and have a unique size and shape that yield significant injury when lodged in the pediatric esophagus. BBs create a local tissue pH environment of 10 to 13 and can induce liquefactive necrosis at the negative pole. This initial injury can progress with further tissue breakdown even after removal. Unfortunately, patients may present with vague symptoms similar to viral illnesses and there is not always a known history of ingestion. Plain film X‐ray can be diagnostic. Exposure can lead to caustic injury within 2 hours. Thus, timely endoscopic removal is the mainstay of treatment. Novel mitigation and neutralization strategies have been implemented into treatment guidelines. These include the preremoval ingestion of honey or sucralfate and intraoperative irrigation with acetic acid. Depending on the severity of injury following removal, careful consideration should be given for potential delayed complications including fistulization into major vessels which often leads to death. The National Button Battery Taskforce and several industry members have implemented prevention strategies such as educational safety outreach campaigns, child‐resistant packaging changes, and warning labels. Governmental regulation and industry changes are key to limit not only the amount of BB ingestions, but also the devastating consequences that can result. Anonymous reporting of BB injuries through the Global Injury Research Collaborative has been made convenient and centralized through the advent of a user‐friendly smartphone iOS/App Store and Android/GooglePlay application called the “GIRC App”; all specialists who manage foreign body cases should contribute their cases to help prevent future injuries. BB ingestion must be recognized and treated promptly using a multidisciplinary approach to optimize outcomes for these patients. Ultimately, a safer BB technology is critically needed to reduce or eliminate the severe and life‐threatening injuries in children. Level of Evidence 5

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Section: Clinical Considerationsmentioning

confidence: 99%

Current management of button battery injuries

Sethia

Gibbs

Jacobs

et al. 2021

Laryngoscope Investig Oto

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“…Foreign bodies such as a battery can cause early mucosal necrosis. 7 The type of foreign body aspirated from the tracheostomy differs from other tracheobronchial foreign bodies. The most common foreign bodies in our study were voice prosthesis and cleaning brush (Table 5).…”

Section: Discussionmentioning

confidence: 99%

Accidental Foreign Body Aspiration Through Tracheostomy Inlet; 26 cases

et al. 2022

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Background: Foreign body aspiration from tracheostomy is very rare, and materials related to tracheostomy are usually aspirated. This condition, which can lead to serious complications, can be treated using bronchoscopic procedures. In this study, we aimed to present our clinical experience in foreign body aspiration via tracheostomy. Methods: Data from 26 patients who presented to our hospital for foreign body aspiration via tracheostomy from 2006 to 2020 were analyzed retrospectively. Results: Foreign bodies were removed by fiber optic bronchoscopy in 15 (57.7%) cases, by rigid bronchoscopy in 9 (34.6%) cases and both methods were used in 2 (7.7%) cases. During bronchoscopy, local anesthetic procedures were used in 13 (50%) cases and general anesthesia was used in 11 (42.3%) cases. No anesthesia was used in two (7.7%) patients who underwent bronchoscopy under intensive care conditions. While the mean operative time for flexible bronchoscopy was 8.77±0.83 (CI: 26.03–29.43) minutes, the mean operative time for rigid bronchoscopy was 27.73±2.53 (CI: 26.03–29.43) minutes. Conclusion: Both rigid bronchoscopy and fiberoptic bronchoscopy (FOB) have advantages and disadvantages in foreign body removal. In our opinion, it is more reasonable to perform fiber optic bronchoscopy first in patients with a tracheostoma. In the light of our experiences, fiber optic bronchoscopy does not require general anesthesia and the operation time is shorter than rigid bronchoscopy. This feature makes fiber optic bronchoscopy advantageous.

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“…The tissue damage due to button batteries occurs through three mechanisms, the first being the penetration of the alkaline electrolyte solution in the battery into deep tissues as a result of alkaline necrosis in the tissue, the second being the damage caused by cumulative electrical current, and the third being because of the pressure necrosis of the button battery (17,20). It is already known that BBs cause more rapid and serious damage in humid environments such as the mucosa (23). The resistance of an electrolysis cell depends on the electrode area (a), the electrode distance (d), and the conductivity of the medium (σ) (r (c) = d / aσ) (23).…”

Section: Discussionmentioning

confidence: 99%

“…It is already known that BBs cause more rapid and serious damage in humid environments such as the mucosa (23). The resistance of an electrolysis cell depends on the electrode area (a), the electrode distance (d), and the conductivity of the medium (σ) (r (c) = d / aσ) (23). The distance between the electrodes reduces the resistance and the current increases.…”

Section: Discussionmentioning

confidence: 99%

Investigation of Injuries Due to Different Types of Button Batteries Stuck in Ear Canals

Akgül¹,

Bakırtaş²

2021

tr-ent

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Objective: Button Batteries (BB) stuck in the Ear Canal (EC) have a special importance among foreign bodies in terms of causing complications depending on the length of time they remain in place, especially in children. In the present study, the purpose was to compare the damaging effects of frequently used BB chemicals on EC and the differences among them. Material and Methods: After 4 EC models prepared from freshly frozen cadaveric bovine ears were thawed, Lithium, Alkaline, Silver-oxide, and Zinc-air BBs with similar size were placed respectively in the canals as the negative poles in contact with the skin. The voltage, tissue temperatures, and pHs of the BBs were measured and visual damage was photographed at the 3 rd , 6 th , 12 th , and 24 th hours. The BBs were removed at the end of the 24 th hour, and EC models were examined histopathologically in a single-blind manner. Results: Although the visual damage could be observed in the first 1.5 hours in ECs with Lithium, Alkaline, and Silver-oxide BBs, it was observed that this time extended to 2.5 hours in Zinc-air. The highest pH value was measured in lithium BB at the end of 24 hours, and the lowest pH value was measured in Zinc-air BB. The least voltage loss was measured in alkaline BB, and not all BB types caused significant changes in tissue temperatures for 24 hours. No significant tissue necrosis depth was detected in Zinc-air BB, but it was most common in Lithium, Silver-oxide, and Alkaline BBs, respectively. Conclusion: All BB chemicals, especially Lithium BB, might cause alkaline necrosis at varying degrees by increasing the pH in EC models without any heat change. Zinc-air BBs, which are generally used in hearing aids, appear to have less damage potential compared to others.

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Severe tracheobronchial harm due to lithium button battery aspiration: An in vitro study of the pathomechanism and injury pattern

Cited by 7 publications

References 41 publications

Current management of button battery injuries

Current management of button battery injuries

Accidental Foreign Body Aspiration Through Tracheostomy Inlet; 26 cases

Investigation of Injuries Due to Different Types of Button Batteries Stuck in Ear Canals

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