Real-Time Video-Assisted Retrieval of Airway Foreign Body in Very Young Pediatric Patients

Objectives

Advancements in medical endoscopy and techniques of rigid bronchoscopy for foreign body removal have enabled higher diagnostic accuracy, reduced morbidity and precise manipulation. However, in pediatric patients, endoscope-combined forceps may be too big to fit into the small sized airway. Here we present our method of endoscope assisted rigid bronchoscopy in pediatric patients and compare the clinical benefits with conventional naked-eye rigid bronchoscopy.

Methods

We used a 2.7 mm, 0° straight endoscope and small caliber grasping forceps with 3.0 to 4.5 mm sized rigid bronchoscopy for very young (<3 years of age) patients of foreign body aspiration. As an assistant held the rigid bronchoscope in situ, the operator could manipulate the endoscope and forceps bimanually. With endoscopic guidance, the foreign body retrieval was performed carefully. The clinical advantages were compared between our endoscope-assisted method (n=29) and the conventional bronchoscopy method (n=33) in terms of operation time and recovery (hospital stay).

Results

Bimanual endoscope-assisted rigid bronchoscopy method was technically feasible and safe. The operation time was less, compared to the conventional technique and the patients recovered more quickly. In all cases, our method completely removed the foreign body without need of a second bronchoscopy procedure.

Conclusion

Bimanual endoscope-assisted retrieval of airway foreign body in very young age pediatric patients was superior to the conventional naked-eye method concerning accurate manipulation and safety.     

Pediatric Aerodigestive Foreign Body Injuries Are Complications Related to Timeliness of Diagnosis

Foreign body (FB) injury from aspiration or ingestion is a common pediatric health problem. Diagnosis relies on clinical judgment plus medical history, physical examination, and radiographic evaluation. A multi-institutional review of 1269 FB events revealed that 85% were correctly diagnosed following a single physician encounter. However, 15% of the children had an elusive diagnosis(>1 week), despite previous evaluation. Delays in diagnosis were seven times more likely to occur in aspirations than in ingestions. Secondary injuries(e.g., pneumonia and atelectasis) occurred in 13% of airway FBs but in only 1.7% of esophageal FBs. Plain radiographs were used in 82% of children, and special studies (e.g., fluoroscopy) in only 7%. We conclude that diagnosis of FB injury in children is frequently achieved at the initial evaluation but that continued surveillance by follow-up visits to health care facilities from parents and other caretakers is important, to reduce pulmonary injuries.     

Management of complicated airway foreign body aspiration using extracorporeal membrane oxygenation (ECMO)

ObjectivesSuccessful removal of an airway foreign body can be very challenging. We present three patients with airway foreign body aspiration successfully treated using extracorporeal membrane oxygenation (ECMO). Their clinical presentation and findings will be reviewed to determine when ECMO should be considered for treatment.Study designRetrospective multi-institutional review of a case series of patients with airway foreign body who underwent successful treatment using ECMO.MethodAfter institutional review board approval, the use of ECMO during airway foreign body procedures in children was reviewed from the pediatric research in otolaryngology (PRO) network. This network comprises of over 20 Children's hospitals to improve the health of and healthcare delivery to children and their families with otolaryngology conditions. Specific parameters were recorded for each patient.ResultsThree children presented with airway foreign body and required ECMO for successful removal. Mean age was 18 months. Presenting symptoms included severe and worsening respiratory distress. Indications for ECMO included an inability to perform rigid bronchoscopy due to the child's unstable respiratory status and an airway foreign body lodged in the trachea that could not be removed without potential loss of airway support. All three children underwent successful removal of their airway foreign bodies. There were no complications from ECMO or bronchoscopy.ConclusionECMO may be a useful adjunct in cases of life threatening airway foreign body aspiration.     

Plastic bronchitis resulting in complete bronchial obstruction in an otherwise healthy child

Plastic Bronchitis is a rare condition in the pediatric population in which large casts fill the bronchi leading to airway obstruction. The classification scheme proposed by Seear divides the bronchial casts into inflammatory and acellular types. Inflammatory casts are most commonly seen with primary lung diseases, while acellular casts are frequently seen in children with congenital heart disease. Here, we present the case of a previously healthy child that presented with complete bronchial obstruction from plastic bronchitis requiring endoscopic removal.     

小儿支气管异物79例分析

本文报告一九八九年一月至十二月收治的79例气管支气管异物,均在全麻下经口支气管镜直接插入法取出异物,抢救或功率100%,无手术并发症,无气管切开。     

Foreign body in bronchus: An unusual presentation

Exogenous foreign bodies in the trachea bronchial tree are not uncomion particularly in children. Children who are not given proper individual attention at an early age are more hable to ingest or inhale foreign body.     

呼吸道异物患儿气质特点的临床研究

目的：探讨0～3岁呼吸道异物患儿的气质特点,了解其心理特征,指导小儿教养,培养身心健康的宝宝。方法：呼吸道异物住院0～3岁患儿251例,采用儿童气质软件及气质测查问卷,由家长填写问卷配以计算机录入分析结果的形式进行评估。结果：小儿气质类型中,中间偏易养型占32．3％,易养型31．1％,难养型23．1％,启动缓慢型7．5％,中间偏难养型6．0％。不同性别的小儿气质类型的分布差异无统计学意义（P〉0．05）。不同性别及年龄组小儿气质维度分值比较差异有统计学意义（P〈0．05）。结论：中间偏易养型、易养型是0～3岁小儿呼吸道异物患儿的主要气质类型;部分气质维度在不同性别和年龄间存在差异,应根据不同性别及年龄段小儿的特点给予针对性的教育和指导,促进小儿健康成长。     

Foreign body in tracheobronchial tree

Inhalation of foreign body into the tracheobronchial tree is a medical emergency sometimes resulting into sudden death. The current mortality rate due to foreign body inhalation ranges from 0% to 1.8%. Children with or without positive history of aspiration were examined and diagnosis was made on the basis of history, clinical findings, radiological evaluation and strong index of suspicion. A review of 30 cases of suspected foreign body aspiration revealed, children between 6 months were found to be very vulnerable to aspiration. Majority of children were boys. 80% of the patients had positive history of inhalation. Only 50% of the patients presented immediately i.e. within 24 hours after aspiration. Common symptoms were cough and respiratory distress. Decreased air entry was the significant clinical sign (50%). Obstructive emphysema and mediastinal shift were found in the majority of cases (50%). Rigid bronchoscopy under general anaesthesia and patient ventilating using a jet ventilator is a very safe and effective technique.     

The complimentary role of diagnostic and therapeutic endoscopy in foreign body aspiration in children

Objective

To review the importance and benefits of flexible bronchoscopy and rigid bronchoscopy in airway foreign body inhalation in children. Prompt diagnosis will lead to safer outcomes when both types of endoscopy are employed within the operating room setting.

Methods

Retrospective review of all cases of foreign body inhalation seen and treated in our Department between July 1986 and December 2010.

Results

Three-hundred and ten children were admitted to our Department from Pediatric Emergency Room for a suspected foreign body inhalation. All patients with suspected FB inhalation underwent bronchoscopy. Of 310 evaluations of tracheobronchial tree performed at our Department, 104 were negative, while an airway FB were observed and removed in 206 cases.

Conclusions

Rigid bronchoscopy under general anesthesia is an extremely accurate surgical technique to identify, localize and remove airway foreign body. In our experience, flexible bronchoscopy under total intravenous sedation and topical anesthesia is very useful in doubtful cases to absolutely exclude the presence of foreign body in upper airway tracheobronchial tree.     

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.     

Foreign bodies in the tracheobronchial tree: A prospective study of fifty cases

Aspirated foreign bodies continue to present challenges to the otorhinolaryngologists—the major issues being accurate diagnosis and speedy and safe removal of the foreign bodies. Tracheobronchial foreign bodies are most common in the 1–3 year age group and are usually of vegetative origin. The most common signs and symptoms of tracheobronchial foreign bodies are cough, wheeze and decreased air entry on the affected side. Diagnostic bronchoscopy is recommended in all children presenting with a history of sudden onset of cough, choking spell, an unexplained acute wheeze, or a chronic pulmonary infection. The present study was undertaken to study the varied clinical presentations of tracheobronchial foreign bodies.     

Efficacy of manual jet ventilation using Manujet III for bronchoscopic airway foreign body removal in children

Objectives

To evaluate the efficacy of a manual jet ventilation device for bronchoscopic removal of foreign bodies in children.

Methods

360 children aged from 10 months to 12 years old undergoing rigid bronchoscopy for airway foreign body (FB) removal from February 2005 to June 2009 were included in the study. Patients were randomly divided into three groups of 120 patients per group (S, P and J). In group S, anesthesia was induced with propofol and γ-hydroxybutyrate sodium and maintained by intermittent bolus administration of propofol; the patients were breathing spontaneously throughout the procedure. In group P, anesthesia was induced with propofol (4-5 mg/kg), fentanyl (1-2 μg/kg) and succinylcholine (2 mg/kg). Mechanical ventilation was performed through the side arm of the rigid bronchoscope. In group J, the patient received propofol, fentanyl and succinylcholine as the same doses administered in group P, and manual jet ventilation was performed by using the Manujet III device. Condition for insertion of bronchoscope, occurrence of hypoxemia, successful rate of FB removal, the duration of the operation, the time of emergence and recovery from anesthesia, and perioperative complications (adverse events) were recorded.

Results

Groups P and J had significantly higher rates of successful bronchoscope insertion (P < 0.05), significantly higher success rates for FB removal (P < 0.05), and lower incidences of hypoxemia during intra- and post-operative periods when compared with group S. Perioperative complications were lower (P < 0.05), duration of operation was shorter, and emergence from anesthesia was faster (P < 0.05) in groups P and J when compared with group S. Incidences of hypoxemia were lower in Group J when compared with Group P (P < 0.05).

Conclusion

This study confirmed the safety and efficacy of performing manual jet ventilation with Manujet III in foreign body removal by rigid bronchoscopy in children.     

Pneumothorax secondary to foreign body inhalation in an infant

An unusual case of pneumothorax secondary to inhalation of a vegetative foreign body in a seven month old child is presented here for its rarity. Proper and timely intervention could save the child.     

Long-standing inhaled foreign bodies in children: Characteristics and outcome

ObjectiveAspirated foreign bodies in children present a potentially life-threatening condition and can be challenging to diagnose. This study aims to elucidate the characteristics and outcome of children with long-standing aspirated foreign bodies.MethodsRetrospective case series of all cases of confirmed long-standing aspirated foreign bodies (LSAFB) between January 2003 to December 2015 in a single paediatric tertiary-level institution, defined as more than two weeks from choking episode or beginning of symptoms.ResultsClinical files and operative records on 227 patients were screened and 35 children were confirmed to have been treated for LSAFB as per definition above. Median time to presentation was 4 weeks (mean 8.8 weeks). Eighty-six percent presented with cough and 51% with dyspnoea. Abnormal chest X-ray findings were found in 28 out 31 patients (90%). Organic foreign bodies (22) were more common than inorganic (14). Intraoperative granulation tissue was demonstrated in 89% of patients and in 46% of patients this was regarded as significant (defined as obstructing more than 50% of the involved airway lumen). Mean length of stay was 2.5 days. Nine patients (26%) had 11 respiratory complications; there were no mortalities.ConclusionsPaediatric LSAFB poses an uncommon diagnostic dilemma as there is often no witnessed history of aspiration event; and signs, symptoms and chest X-Ray findings are often non-specific. Laryngobronchoscopy is made more difficult by the presence of granulation tissue and the sequelae of prolonged non-treatment is a higher rate of chronic respiratory disease.     

Foreign bodies in the tracheobronchial tree. Special references to experience in 97 children

The case records of 110 patients (97 children and 13 grown-ups) with foreign bodies in the tracheobronchial tree during a period of 14 years (1970-1983) are reviewed. Atypical histories, misleading clinical and radiological findings and delayed diagnoses due to misinterpretations by the patients or their physicians were seen from time to time. Other findings in this survey were that organic material prevailed, with the majority of the objects in the right bronchial tree; there was a male predominance and the most common age for inhalation of a foreign body was about two years. Bronchoscopic extraction was the routine and only in one boy had the object to be removed by the transthoracic route. The venturi technique with oxygenation through the bronchoscope was applied at the extraction procedures. This principle for ventilation during general anaesthesia creates excellent working conditions for the endoscopist. The hazard at the removal of a foreign body is thereby reduced.     

An unusual impacted foreign body in the nasopharynx

Foreign bodies are comonly seen in upper acrodigestive tract but these are lodge very infrequently in masopharywr.various types of foreign bodies like leech whitsle wood piece marble coin etc. have beenremoved from the masopharywr.It is unusual for a foreign body to get impacted in adcnoid tissue of the masopharywr. This article highlights one such rare incidence where a button was impacted in the adenoid mass, which could be retrived only after adenoidectomy