儿童气管支气管异物的并发症及处理

目的分析儿童气管支气管异物的并发症及探讨并发症处理方法。方法回顾分析2008年1月～2010年4月湖南省儿童医院收治的1020例气管支气管异物的治疗经过。结果 1020例儿童气管支气管异物中并发支气管肺炎935例、肺不张478例、肺气肿480例、皮下气肿25例、纵隔气肿6例、皮下及纵隔气肿5例、气胸3例,其中230例患者合并两种及两种以上并发症。2例气胸患者,在行胸腔闭式引流待肺复张至80%后取出异物,另1例气胸及其他并发症未做特殊处理,在异物取出后经抗炎治疗3～5 d后恢复正常。结论支气管肺炎是气管支气管异物最常见的并发症,气胸是危重及少见的并发症。气管支气管异物的并发症的处理最为重要的是将异物取出,伴明显呼吸困难则需紧急处理;严重气胸需行胸腔闭式引流,待肺复张后取出异物,其他并发症未做特殊处理在异物取出后得到恢复。     

32例气管支气管异物的临床分析

气管异物系指声门裂以下的气管支气管内异物,气管支气管异物是耳鼻咽喉科常见的急症之一,多见于1～5岁儿童。其严重性决定于异物的性质、种类、大小和造成气道堵塞的程度,轻者可致肺部损害,重者为猝死原因之一。由其所致的气管支气管并发症是导致气管支气管异物患儿死亡的原因之一。     

小儿气管异物合并气管破裂的手术治疗

气管、支气管异物临床常见,是耳鼻咽喉科的危急重症,多发生于儿童,严重危及儿童的生命安全.但气管、支气管异物合并气管破裂却鲜有报道.2004年7月至2009年7月,我院收治支气管异物合并气管破裂患儿3例,均予开胸手术,取出异物并修补气管破裂口,取得满意疗效,现将治疗及体会报告如下.     

气管支气管异物3018例临床分析

目的探讨气管支气管异物的诊断、治疗方法及效果。方法回顾分析1980年1月-2006年12月我科治疗的3018例气管支气管异物的诊治过程。结果气管支气管异物以1—3岁儿童最常见（68％），植物类异物最常见（85．9％）。2867例在表麻下取出，2969例经直接喉镜或硬支气管镜成功取出。无术中或术后死亡病例。结论对气管支气管异物及时正确的诊断、合适的麻醉与手术方法的选择、术中应变能力，尤其是术者熟练的手术技能对减少并发症、降低死亡率至关重要。表麻硬支气管镜下异物取出术是治疗儿童气管支气管异物最适用的方法。     

气管性支气管畸形伴支气管异物1例

目的提高对气管性支气管疾病的认识和诊断水平。 方法回顾我院收治的1例气管性支气管伴支气管异物患儿病历资料,并复习相关文献。结果该患儿因支气管异物行螺旋CT气道三维重建时,发现伴有气管性支气管,支气管异物取出,气管性支气管未予处理。结论气管性支气管是起源于气管隆凸上方气管壁的支气管异位或多余畸形,螺旋CT肺气道三维重建可明确诊断,若无临床症状可不予处理。     

多层螺旋CT三维重建在诊断气管支气管异物中的应用

目的 评价多层螺旋CT(multilayer spiral computed tomography,MSCT)三维 重建对气管支气管异物诊断的价值。方法 对30例怀疑为气管支气管异物的患 者,实施肺螺旋CT平扫及三维重建,与硬性支气管镜下手术情况对比,分析各种重建方法对支气管异物的显示情况及诊断价值。结果 30例患者均获清晰图像,23例异物部位与术中所见一致,出现位移1例,假阴性1例,异物咳出后检查3例, 左主支气管狭窄1例,吸入性肺炎1例,均未见异物。各种重建方法均可清楚显示气管、支气管异物的位置、形状、大小及异物所致气管、支气管狭窄的部位、程度和外形改变。结论 螺旋CT及图像后处理技术在气管支气管异物诊断中具有重要的临床应用价值。     

成人气管及支气管异物

气管及支气管异物为临床急症之一,主要发生于儿童,但也可发生于成年人或老年人,成人气管及支气管异物常常与手术创伤和意外事故有关,其临床特征不同于儿童。为了进一步探讨成人气管及支气管异物的临床特征,总结诊断和治疗经验,我们回顾分析32例患者的临床资料,报道如下。     

硬质支气管镜联合纤维支气管镜治疗气管异物9例

气管、支气管异物是小儿耳鼻咽喉科的常见急症之一,是造成儿童死亡的重要原因。一旦确诊必须及时进行气管镜下异物取出术。但是部分多发性气管异物及气管或主支气管伴叶、段支气管异物,而镜下取出较困难。我科近年来采用硬质支气管镜联合纤维支气管镜（纤支镜）取多发性气管异物9例,获得满意效果。现报道如下。     

儿童气管支气管异物400例临床诊治分析

目的 分析深圳地区儿童气管、支气管异物的临床特征,探讨特殊病例的诊疗方式.方法 将2018年10月～2021年10月于深圳市儿童医院就诊确诊气管、支气管异物的400例患儿纳入研究.将其性别、年龄、诱因、症状、异物种类、异物部位、异物滞留时间、异物史、并发症记录并加以分析.结果 气管异物常发生在0～2岁幼儿(89.8％)...     

儿童呼吸道特殊异物的治疗

儿童气管、支气管异物是耳鼻咽喉科的常见急症。而气管、支气管的特殊异物常见于学龄儿童。异物进入呼吸道后,如在气管内上下活动引起剧烈呛咳,撞击声门易造成窒息而危及生命。如嵌塞于一侧支气管内会引起肺不张和肺部感染,手术取出难度     

Treatment of 38 cases of foreign body aspiration in children causing life-threatening complications

Objectives

The objectives of this study were to discuss the clinical magnifications and therapies of tracheobronchial foreign body aspiration (FBA) in children causing life-threatening complications.

Method

We retrospectively reviewed 38 cases of FBA with serious complications in children out of 749 cases of FBA in children that had been admitted to and treated in the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China, from June 1990 to December 2007. The complications included pneumothorax (14 cases); pneumomediastinum (6 cases); pulmonary abscess (7 cases); massive hemorrhage, tracheoesophageal fistula and exudative pleurisy, in 3 cases, respectively; and heart failure (2 cases). Each child's symptoms, including duration, physical findings, chest radiographs, including CT, and the nature of the foreign body causing the complications due to FBA were recorded.

Results

Among the 38 cases of FBA, the FBs in 36 cases were removed by bronchoscopy, and in 2 cases the FBs were removed via thoracotomy. Except for 1 case that resulted in death, the other 37 children were completely cured and discharged to home from the hospital.

Conclusions

For children with FBA who experience severe and life-threatening complications from FBA, our recommendation is that emergency measures should be available during FBs removal. With correct judgment and management of the complications of FBA, the mortality rate can be reduced.     

Late diagnosis of foreign body aspiration in children with chronic respiratory symptoms

BACKGROUND: Children with undiagnosed and retained foreign bodies (FBs) may present with persistent respiratory symptoms. Delayed diagnosis is an important problem in developing countries and several factors affect the delay. OBJECTIVES: To investigate, the incidence of clinically unsuspected foreign body aspiration (FBA) in our flexible bronchoscopy procedures, the causes resulting in late diagnosis of FBA, and the incidence of the complications of FBA according to elapsed time between aspiration and diagnosis. METHODS: We reviewed the records of all the patients who underwent flexible bronchoscopy between 1997 and 2004 in our clinic. Patients with FBA were identified and their medical records were reviewed. RESULTS: During the study period, 654 children underwent flexible bronchoscopy; 32 cases (4.8%) of FBA were identified. Median age of patients was 29.5 months at presentation with a median symptomatic period of 3 months. None of the patients had a history of FBA. The most common misdiagnosis was bronchitis. Flexible bronchoscopy was performed to these patients within 1 week following presentation. In 87% of the patients (n=28), FBs were in organic nature. Patients were followed up for 21.0 months after removal of the FBs. Fifty-three percent (n=17) of the patients had a complete remission after bronchoscopic removal of the FBs. However, nine (28.8%) patients had chronic respiratory problems and six patients (18.8%) developed bronchiectasis. CONCLUSIONS: Atypical or prolonged respiratory symptoms should alert the physician and clinical and radiological findings should be carefully evaluated for a possible FBA. Delay in diagnosis and treatment of FBA should be avoided to prevent complications.     

Tracheobronchial foreign bodies in infants

Objective

Tracheobronchial foreign body aspiration (FBA) is a common cause of respiratory distress between 1 and 3 years of age. Literature on airway foreign bodies in this age group is abundant; however no study has addressed this problem in infants exclusively. This study aimed to review the clinical presentation, management and outcome of infants with tracheobronchial foreign bodies at a referral tertiary care hospital over a decade.

Methods

102 infants who underwent bronchoscopy for suspected FBA from 1997 to 2007 were retrospectively reviewed. Details of demographic data, clinical features, radiologic and bronchoscopic findings, postbronchoscopy events and eventual outcome were analysed.

Results

The mean age was 10.5 months. 8 (7.8%) were 0-6 months of age, the youngest being 2 months. Males outnumbered (72:30) females. 10 (9.8%) presented secondarily after treatment elsewhere, 6 of them were initially misdiagnosed. The onset-presentation interval ranged from 1 day to 3 months, 41 (40.2%) reporting within a day and 19 (18.6%) a week after onset. 20 (19.6%) had no history suggestive of FBA but harboured airway FBs at bronchoscopy. The clinical triad of cough, respiratory distress and stridor was highly predictive of FBA. 8 (7.84%) had no abnormal physical findings while 8 (10.81%) had grossly normal chest radiographs. All the patients underwent emergency/elective rigid bronchoscopy (Karl Storz system) under general anesthesia as in-patients. The physical findings did not always correlate with radiology or bronchoscopic location of the FB. A peanut cotyledon was the commonest FB retrieved across infancy; in 5 (4.9%) no FB was found/identifiable. 2 required postbronchoscopy mechanical ventilation and 1 a repeat bronchoscopy. There were 6 complications but no mortality in the series. The average hospital stay was 1.4 days. At a week's follow-up, all were asymptomatic and well.

Conclusions

The clinical presentation, diagnosis and management of FBA in 102 infants are presented and certain peculiar features are described. A high index of suspicion coupled with a combination of history, physical signs and radiology is more conclusive than any of them in isolation. Availability of expertise and endoscopic equipment ensures a favourable outcome without significant morbidity and mortality.     

Delayed diagnosis and treatment of foreign body aspiration in China: The roles played by physician inexperience and lack of bronchoscopy facilities at local treatment centers

Objective

We examined if lack of on-site bronchoscopy facilities and the inexperience of initial treating physicians contributed to missed or delayed diagnosis of tracheobronchial foreign body aspiration (FBA) in pediatric patients presenting with respiratory distress.

Methods

The medical records of 340 patients examined by bronchoscopy in our otolaryngology department from January 2009 to August 2012 were reviewed. Age, gender, clinical history, findings on physical examination, facilities at the initial treatment site (bronchoscopy or not), bronchoscopic findings (type and location of the FB), and initial diagnosis, were examined in terms of the delay between initial treatment and bronchoscopy-based diagnosis of FBA.

Results

The vast majority of patients (324/340, 95.29%) were 3 years of age or younger and a foreign body was located in 309 (90.88%). Of these 340 cases, 261 had been referred from other facilities (76.76%) whereas 79 had come directly to our hospital (23.24%). The median delay between initial treatment and bronchoscopic diagnosis was significantly shorter in those treated initially in our institution compared to referrals (24 h [1 h to 60 days] vs. 168 h [1 h to 366 days]; P < 0.01). The initial diagnosis was FBA in 135/261 referral cases (51.72%), significantly lower than in cases first treated in our institution (69/79, 87.34%; P < 0.01). Foreign body aspiration was confirmed in 127/135 referral cases (94.07%) and 62/69 directly treated cases (89.86%) (χ² = 1.193, P > 0.05). Of the 126 referral cases diagnosed with other conditions before coming to our hospital, FBA was confirmed in 114. Complications were significantly less frequent in cases treated directly than in referrals (24/79, 30.38% vs. 155/261, 59.39%; P < 0.01).

Conclusions

Local treatment facilities, most lacking bronchoscopy facilities and physicians who were trained to recognize FBA, misdiagnosed at least 44% of patients with respiratory distress and this led to significant delays in treatment. Greater regional access to bronchoscopy and improved training of primary care physicians will enhance diagnostic accuracy and reduce treatment delays.     

The heterodox nature of "Turban Pins" in foreign body aspiration; the central anatolian experience

OBJECTIVE: The aim of this study is to determine the age and sex distribution and the nature of aspirated foreign bodies (FBs). We also compared Turban Pins (TP) with other FBs and discussed the extracting techniques. METHODS: From 1987 through 2006, 414 patients were managed and the records of the patients were retrospectively reviewed. RESULTS: Girls (56%) were influenced much more than the boys (44%). The median age was 4, however median age for girls and boys were 11 and 2, respectively. The 50% of the foreign body aspiration (FBA) were observed in the first years of life. There was also a great tendency to occur in the adolescent age group (32%), especially for girls. The most commonly aspirated foreign body was Turban pin (TP) (n=121) among 332 foreign bodies. FBs were successfully removed by rigid bronchoscopy in 94% of the patients. In patients who had a negative history (n=49), bronchoscopy was performed according to clinical suspicion, and it revealed foreign bodies in 41%. Thoracotomy was performed in eight (2.4%) patients. We had no mortality. CONCLUSIONS: These cases showed us that the type and age groups of FBA varies according to cultural conditions. We found that TP aspiration has different characteristics and it deserves a special attention. Suspicion is an important indication for bronchoscopy. We prefer rigid bronchoscopy because success rate is satisfactory.     

Foreign body aspiration in children: A nationwide survey in Japan

Background

Foreign body aspiration (FBA) is a common cause for a respiratory emergency in young children and can be a life-threatening event. We, therefore, conducted the first nationwide survey in Japan.

Methods

We asked doctors of 261 tertiary hospitals across the nation to fill out a case card of FBA-diagnosed cases they had experienced for the past 2 years. In the case card, age and gender of the patients, elapsed time until being referred to the hospital, presenting symptoms, previous diagnosis, suspected aspiration episode, type and location of aspirated foreign body, and consequences were inquired. This retrospective survey was carried out during 21 months, since January 2005 through September 2006.

Results

Replies from 169 hospitals (64.8%) revealed that 163 cases of FBA had been treated in 114 hospitals during the past 2 years. Median age of cases was 1 year (2 months to 15 years), and 66.5% were male. Only 50.9% of the cases were referred to hospitals within 24 h. Comparing these early-diagnosed cases, children with delayed diagnosis had similar age and sex distribution. In respect of presenting symptoms, characteristic ones such as choking or dyspnea were observed significantly more often in the early-diagnosed cases, whereas significantly predominant symptoms in children with delayed diagnosis were non-specific ones like coughing and wheezing (both, p < 0.05). Although significantly more cases with early diagnosis reported suspected aspiration episodes (p < 0.05), even in the delayed diagnosis group more than half cases (65%) had suspected episodes as well. Severe consequences occurred in seven cases (4.3%): four cases of irreversible hypoxic brain damage and one death due to multiorgan failure in the early diagnosis group; one bronchiectasis and one recurrent pneumonia in the delayed diagnosis group.

Conclusions

Characteristics of FBA among children in Japan were not substantially different from the reports from other countries. Suspected episodes were important, and there were some differences in presenting symptoms between early and delayed diagnosis cases. However, there are still no key sings to make a prompt diagnosis. In order to prevent FBA and make a timely diagnosis, continuous and extensive educational programs should be provided.     

Food choking hazards in children

Objectives

To review the literature on pediatric food choking risks, with the long-term goal of supporting legislation regulating the production, labeling, and distribution of high-risk foods.

Methods

A PubMed search (Keywords: choking, obstruction, asphyxiation, foreign body, food) was conducted in July–September 2010 with publication dates ranging from 1966 to 2010. Study selection: Articles related to pediatric foreign body aspiration (FBA) were selected by three independent reviewers. 1145 articles were initially identified. Abstracts were then screened utilizing a tool designed to isolate relevant pediatric choking events; this tool helped to only select abstracts which presented data on patients younger than 18 years of age who had choked on food items. Through this, a total of 72 pertinent articles were isolated (55 observational studies, 17 case reports/series). Data extraction: For each study, patient age, sex, foreign body location, presenting signs and symptoms, utility of radiographic studies, and type of foreign body detected in the majority of study participants were determined. A “majority” of patients for each study was predetermined arbitrarily to be 2/3 of the studied population.

Results

The majority of patients in each observational study was determined to be: male (87% of all studies) and age <5 years (95% of all studies). Aspirated foreign bodies were mostly detected in the right main bronchus foreign body (72% of all studies), and there were abnormal radiographic signs (81% of all studies) at the time of evaluation. Food-object foreign bodies were the most frequent factors associated with choking (94% of all studies).

Conclusion

Childhood aspiration of food-objects is a significant public health issue. Although there is substantial legislation regulating non-food items that pose a choking hazard, equivalent guidelines do not exist for high-risk foods. Our study identifies and confirms several risk factors for pediatric FBA events. In doing so, it echoes the concerns and suggestions of various groups in supporting the development of legislation which may reduce the incidence of food-object aspiration.     

Foreign body aspiration in children: The value of diagnostic criteria

Objective

Foreign body aspiration (FBA) is a serious problem in children. While bronchoscopy should be performed in all patients with aspiration; patients without aspiration should be carefully excluded to avoid an unnecessary bronchoscopy. In this study we analyzed the details of our series, complication rates and compared the diagnostic findings between patients with an aspirated FB and those without. We also calculated the sensitivities, specificities, positive predictive values and negative predictive values of clinical history, symptoms, physical examination findings and radiological findings in patients with suspected FBA (sFBA). Finally, we evaluated the validity of our bronchoscopy indications in these patients.

Methods

We reviewed the data of 207 patients who underwent rigid bronchoscopy for sFBA. We used clinical history, symptoms, physical examination and radiological findings as diagnostic findings. Complication rates in addition to these four diagnostic criteria constitute our indications for performing a rigid bronchoscopy.

Results

After excluding 15 patients with radiopaque FB or previous fiberoptic bronchoscopy, 138 of 192 patients had an aspirated foreign body. The sensitivity and specificity of clinical history, symptoms, physical examination findings and radiological findings were 90.5% and 24.1%, 97.8% and 7.4%, 96.4% and 46.3, and 71.7% and 74.1% respectively. There was only one major complication which caused moderate neurological sequelae. There was no mortality and no thoracotomy or tracheotomy requirement in this group.

Conclusions

While symptoms, physical examination findings and clinical history had high sensitivities, radiological findings had the highest specificity. Low specificities of clinical history, symptoms and physical examination findings were due to our expanded bronchoscopy indication, which aimed to include all patients with foreign body aspiration. Our low complication rate facilitated the expansion of bronchoscopy indications, even for patients with slight clinical suspicion.     

Diagnóstico y tratamiento precoz de la hipoacusia unilateral o asimétrica en la infancia: recomendaciones CODEPEH

The aim of this document is to improve the management and the treatment of unilateral or asymmetrical hearing loss in children. One in one thousand newborn infants has unilateral hearing loss and this prevalence increases with age, due to cases of acquired and delayed-onset hearing loss.Although the impact on the development and learning processes of children of these kinds of hearing loss have usually been minimized, if they are not treated they will impact on language and speech development, as well as overall development, affecting the quality of life of the child and his/her family.The outcomes of the review are expressed as recommendations aimed at clinical diagnosis and therapeutic improvement for unilateral or asymmetrical hearing loss.     

Anesthesia for tracheobronchial foreign bodies removal via self-retaining laryngoscopy and Hopkins telescopy in children

This study attempted to explore suitable anesthetic methods used for removal of tracheobronchial foreign body (FB) via self-retaining laryngoscopy and Hopkins telescopy in children. 92 cases had undergone FB removal via self-retaining laryngoscopy and Hopkins telescopy or rigid bronchoscopy in our hospital since 2006, of which 56 cases were under intravenous anesthesia and endotracheal intubation with muscle relaxation (IAEI with MR), and the other 36 cases were under intravenous anesthesia with spontaneous breathing (IASB). Operative parameters and intraoperative vital signs were analyzed. Tracheobronchial foreign body was successfully removed in 87 cases, and not found in the other 5 cases. SpO₂ was below 90% transiently in 41 cases, 29 cases of which were under IAEI with MR and 12 cases were under IASB. Laryngospasm and choke were found in 12 cases under IASB. Vital signs including P_ETCO₂ and heart rate were stable in all the cases. The mean surgical time, anaesthetic induction and recovery time of IAEI with MR via self-retaining laryngoscopy group were (5.69 ± 3.43) min, (9.68 ± 1.66) min and (26.13 ± 6.94) min, IASB via self-retaining laryngoscopy group were (21.35 ± 17.25) min, (13.71 ± 3.79) min and (24.64 ± 5.44) min, IAEI with MR via rigid bronchoscopy group were (10.20 ± 5.01) min, (10.31 ± 3.56) min and (25.13 ± 6.21) min, and IASB via rigid bronchoscopy group were (25.35 ± 13.25) min, (14.71 ± 3.61) min and (26.22 ± 5.65) min. It’s a new and wonderful surgical procedure that combining self-retaining laryngoscopy and Hopkins telescopy for removal of tracheobronchial foreign body. IAEI with MR is suitable for bronchial FBA cases via them, while IASB is better for tracheal FBA or complicated cases.