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Saccomanno S, Saran S, Coceani Paskay L, De Luca M, Tricerri A, Mafucci Orlandini S, Greco F, Messina G. Risk factors and prevention of choking. Eur J Transl Myol 2023; 33:11471. [PMID: 37905785 PMCID: PMC10811631 DOI: 10.4081/ejtm.2023.11471] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Choking (or foreign body airway obstruction) is a widespread phenomenon with serious consequences of morbidity and mortality. Choking (often also called suffocation) can be caused by food or inedible objects and leads to various degrees of asphyxiation or lack of oxygen in the blood stream. The incidence is very high in both young children and adults, especially seniors. However, since not all choking episodes end up in the emergency room or become fatalities, they often escape statistics. Although episodes of choking from non-edible bodies are infrequent, they affect mostly young children. Three of the most common risks for choking in general are neurological disorders, dysphagia and dental issues (few or no teeth, unstable or unsuitable prosthesis or orthodontic appliances). The purpose of this study was to evaluate the risk factors of choking and ways to reduce/avoid this event. We reported data on a series of 138 patients admitted to the emergency department following a choking event, at a hospital in Rome, Italy. The age group of the analyzed population ranged from 1 to 88 years, with the most represented age group of these between 40 and 59, with a similar distribution between males and females. The types of foods on which people choked reflected the seasonal, traditional and local foods: 67% of patients reported choking on fish bones followed by meat bones (9%) and artichokes (3%). Three relevant non-food choking elements reported were: orthodontic items, toothpicks and pins (one occurrence each). We also reported on two clinical cases of patients choking on meat and a chicken bone. In conclusion, choking awareness and prevention are essential for implementing potential life-saving precautions. Prevention is the first tool to reduce the occurrence of this event, therefore it is necessary to analyze the risk factors and educate the population to eliminate them. Proper chewing and oral manipulation are paramount functions in preventing choking, along with meal-time supervision if little children and elderly. Then, it behooves the healthcare professionals to disseminate knowledge.
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Affiliation(s)
- Sabina Saccomanno
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila.
| | - Stefano Saran
- Department of Human Sciences, Innovation and Territory, School of Dentistry, University of Insubria, Varese.
| | | | - Martina De Luca
- Dental School, Catholic University of the Sacred Heart, Italy Rome.
| | | | | | - Francesca Greco
- Department of Radiology, New San Giovanni Battista Hospital, Foligno.
| | - Giuseppe Messina
- Department of Human Sciences and Promotion of the Quality of life of San Raffaele University Rome.
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2
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Leeds S, Kim EH. Considerations for the Initiation and Implementation of Early Peanut Oral Immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3275-3276.e9. [PMID: 37805226 DOI: 10.1016/j.jaip.2023.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Stephanie Leeds
- Department of Pediatrics, Section of Allergy and Immunology, Yale School of Medicine, New Haven, Conn.
| | - Edwin H Kim
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
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3
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Loreau C, Caruselli M, Roncin C, Salvi N, Lenoire A, Allary C, De Queiroz M, Belghiti-Alaoui M, Michel F. Pediatric anesthetic for tracheobronchial foreign body extraction: A survey of practice in France. Paediatr Anaesth 2023; 33:736-745. [PMID: 37300331 DOI: 10.1111/pan.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND 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. AIMS The aim of this study was to evaluate the different anesthetic practices for tracheobronchial foreign body extraction. METHODS 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. RESULTS 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. CONCLUSIONS Our study confirms the diversity of practices concerning anesthetic for tracheobronchial foreign body extraction and found reveal differences in practice according to physician experience.
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Affiliation(s)
- Chine Loreau
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Marco Caruselli
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - César Roncin
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Nadège Salvi
- Department of Pediatric Anesthesia and Intensive Care, CHU Necker, Paris, France
- Assistance-Publique - Hôpitaux de Paris, Paris, France
- Centre Université de Paris, Paris, France
| | - Alexandre Lenoire
- Department of Pediatric Anesthesia and Intensive Care, CHU Necker, Paris, France
- Assistance-Publique - Hôpitaux de Paris, Paris, France
- Centre Université de Paris, Paris, France
| | - Chloé Allary
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Mathilde De Queiroz
- Department of Pediatric Anesthesia and Intensive Care, Femme-Mère-Enfant Hospital, Lyon, France
| | - Myriem Belghiti-Alaoui
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Fabrice Michel
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
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4
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Greenlund L, Borden A, Nickel A, Arms J, Kavanagh K, McCoy J, Shaffer A, Snyder V, Tobey A, Roby B. Pediatric peanut aspirations before and after 2015 recommendation for early peanut exposure. Int J Pediatr Otorhinolaryngol 2023; 168:111518. [PMID: 37023556 DOI: 10.1016/j.ijporl.2023.111518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES To investigate if there has been an increase in peanut foreign body aspirations (FBA) in children since the publication of the Learning Early About Peanut Allergy (LEAP) trial, which revealed that early exposure to peanut-containing foods prevented peanut allergies in children at risk of atopic disease. METHODS Retrospective chart reviews were conducted separately at two pediatric institutions. Institutions One and Two reviewed children less than 7 years old who underwent bronchoscopy for FBA over ten-year periods between January 2007 and September 2017 and November 2008 and May 2018, respectively. The proportion of FBAs attributed to peanuts was compared before and after the publication LEAP. RESULTS Out of 515 reviewed cases, there was no change in pediatric peanut aspirations prior to and following the LEAP trial and AAP guideline change (33.5% vs 31.4%, p = 0.70). At Institution One, 317 patients met inclusion criteria. When comparing FBAs before and after LEAP, there were no significant changes in the rate of peanut aspiration (53.5% vs. 45.1%, p = 0.17). Institution Two also found no significant increase in the rate of peanut aspirations before and after the Addendum Guidelines (41.4% vs. 28.6%, p = 0.65) upon review of 198 cases. CONCLUSIONS Multiple institutions demonstrated a non-significant change in the rate of peanut FBAs following the AAP recommendation. Given that peanuts comprise a large proportion of FBAs, it is important to continue to track peanut aspirations. Longer term data tracking is needed from more institutions to further understand how recommendations from other specialties and the media impacts pediatric aspiration outcomes.
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Affiliation(s)
| | - Amy Borden
- Children's Minnesota, Department of Pediatric Emergency Medicine, USA
| | | | - Joseph Arms
- Children's Minnesota, Department of Pediatric Emergency Medicine, USA
| | - Katherine Kavanagh
- Connecticut Children's Hospital, Department of Otolaryngology, Head and Neck Surgery, USA
| | - Jennifer McCoy
- University of Pittsburg Medical Center, Department of Pediatric Otolaryngology, USA
| | - Amber Shaffer
- University of Pittsburg Medical Center, Department of Pediatric Otolaryngology, USA
| | - Vusala Snyder
- University of Pittsburg Medical Center, Department of Pediatric Otolaryngology, USA
| | - Allison Tobey
- University of Pittsburg Medical Center, Department of Pediatric Otolaryngology, USA
| | - Brianne Roby
- Children's Minnesota, Department of Pediatric ENT and Facial Plastic Surgery, USA; University of Minnesota, Department of Otolaryngology- Head and Neck Surgery, USA.
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White JJ, Cambron JD, Gottlieb M, Long B. Evaluation and Management of Airway Foreign Bodies in the Emergency Department Setting. J Emerg Med 2023; 64:145-155. [PMID: 36806432 DOI: 10.1016/j.jemermed.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/03/2022] [Accepted: 12/13/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Airway foreign body can be a life-threatening issue in pediatric and adult patients, and the majority of these patients will first present to the emergency department. OBJECTIVE This article provides a narrative review of the diagnosis and management of airway foreign bodies for the emergency clinician. DISCUSSION Foreign bodies in the upper and lower airways are potentially life threatening. This affects all age groups but is more common in pediatric patients. A history of a witnessed ingestion or aspiration event should raise the clinical suspicion for an aspirated foreign body. Patients with upper-airway foreign bodies are more likely to present in respiratory distress when compared with lower-airway foreign bodies, which often present with more subtle signs. Stridor, drooling, and wheezing suggest respiratory distress, but the presenting clinical picture is often unclear and may only include a cough. Immediate intervention is required in the patient with hemodynamic instability or respiratory distress. Airway management including laryngoscopy, fiberoptic bronchoscopy, and cricothyrotomy may be needed in these patients, with the emphasis on removing the obstructing foreign body and securing the airway. Specialist consultation can assist in retrieving the foreign body and managing the airway. If the patient is stable, imaging and specialist consultation for potential operating room intervention should be considered. CONCLUSIONS An understanding of the presentation, evaluation, and management of the patient with an airway foreign body is essential for emergency clinicians.
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Affiliation(s)
- Joshua J White
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - John D Cambron
- Department of Emergency Medicine, Christus Spohn Shoreline, Corpus Christi, Texas
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas
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6
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Abou-Dakn M, Alexy U, Beyer K, Cremer M, Ensenauer R, Flothkötter M, Geene R, Hellmers C, Joisten C, Koletzko B, Mata J, Schiffner U, Somm I, Speck M, Weißenborn A, Wöckel A. Ernährung und Bewegung im Kleinkindalter. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01519-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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7
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Paediatric asthma - all that wheezes is not necessarily asthma - current diagnostic and management strategies. Curr Opin Pulm Med 2022; 28:258-265. [PMID: 35256553 DOI: 10.1097/mcp.0000000000000874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Asthma is a frequently encountered chronic medical condition encountered in paediatrics, affecting 7% of children under the age of 18 in the United States. Although asthma is one of the more common conditions that is associated with wheezing, there is a broad differential diagnosis to consider. The purpose of this review is to describe other causes of wheezing outside of asthma in a paediatric population and discuss diagnostic and management strategies to consider when evaluating a child or adolescent with wheezing. RECENT FINDINGS The characteristics of the wheezing along with other associated signs and symptoms can be helpful in narrowing the differential diagnosis. The age and the past medical history of the patient are also important aspects to consider when determining next steps in the evaluation and management of paediatric wheezing. In addition to considering other causes of wheezing, it is often necessary to assess for the presence of underlying asthma, and recently updated asthma guidelines from the National Heart, Lung and Blood Institute provide a graded review of various recommendations for making the diagnosis and managing asthma in the clinical setting. SUMMARY It is important to maintain a broad differential diagnosis when evaluating a paediatric patient with wheezing.
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Chang DT, Abdo K, Bhatt JM, Huoh KC, Pham NS, Ahuja GS. Persistence of choking injuries in children. Int J Pediatr Otorhinolaryngol 2021; 144:110685. [PMID: 33819896 DOI: 10.1016/j.ijporl.2021.110685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/18/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Choking injuries are a significant cause of morbidity and mortality in children and represent a significant public health concern. Evaluating trends and the impact of interventions are essential to highlight whether progress has been made and to target public health efforts. OBJECTIVE To investigate how rates of nonfatal and fatal choking injuries have changed before and after 2010 when policy recommendations were made by the American Academy of Pediatrics. METHODS A descriptive study investigating unintentional nonfatal and fatal choking injuries in children aged 0-19 years using national data from 2001 to 2016 through the Centers for Disease Control and Prevention's WISQARS™ and WONDER databases, focusing on the 6 years prior and 6 years after release of the AAP's recommendations. The data was categorized by age, gender, year, and race/ethnicity for descriptive and statistical analyses. RESULTS From 2001 to 2016, there were a total of 305,814 nonfatal injuries and 2347 choking deaths in children from 0 to 19 years. Children under five years of age accounted for 73% of nonfatal injuries and 75% of choking fatalities. There was a statistically significant increase in the nonfatal injuries rate when comparing 2005-2010 and 2011-2016 (19/100,000 versus 26/100,000, respectively). There was a decrease in the choking fatalities rate in all children (0.18/100,000 versus 0.16/100,000, respectively) but no change in fatalities rate for children under five. White and Black children experience nonfatal choking injuries at a higher rate than Hispanics. Black children had highest rates of choking fatalities over Hispanic, White, Asian, and Alaskan or American Indian ethnicities. The lowest rates of death occurred in Asians. CONCLUSIONS Overall rate of nonfatal choking injuries increased, while rate of choking fatalities in children decreased after 2010. However, the choking fatalities rate in 0-4 years olds, the highest risk group, did not change. Racial gaps exist with highest rates of injury in Black children. We must continue to educate and raise awareness of choking injuries, with targeted efforts to address racial disparities.
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Affiliation(s)
- David T Chang
- Division of Otolaryngology and Head and Neck Surgery, Children's Hospital of Orange County, Orange, CA, 92868, USA.
| | - Kaitlyn Abdo
- Chapman University, 1 University Dr., Orange, CA, 92866, USA
| | - Jay M Bhatt
- Division of Otolaryngology and Head and Neck Surgery, Children's Hospital of Orange County, Orange, CA, 92868, USA
| | - Kevin C Huoh
- Division of Otolaryngology and Head and Neck Surgery, Children's Hospital of Orange County, Orange, CA, 92868, USA
| | - Nguyen S Pham
- Division of Otolaryngology and Head and Neck Surgery, Children's Hospital of Orange County, Orange, CA, 92868, USA
| | - Gurpreet S Ahuja
- Division of Otolaryngology and Head and Neck Surgery, Children's Hospital of Orange County, Orange, CA, 92868, USA
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Mohsen F, Bakkar B, Melhem S, Altom R, Sawaf B, Alkhija I, Nahas LD. Foreign body aspiration in a tertiary Syrian centre: A 7-year retrospective study. Heliyon 2021; 7:e06537. [PMID: 33817384 PMCID: PMC8010408 DOI: 10.1016/j.heliyon.2021.e06537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/24/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background Paediatric foreign body aspiration constitutes significant lethal sequela worldwide. This is the first descriptive Syrian study that aims to describe the epidemiology of foreign body aspiration in a tertiary centre in Syria. Methods This is a retrospective cohort study conducted at the Children's University Hospital, Damascus, from 2011 to 2018 during the Syrian crisis. The children underwent rigid bronchoscopy at Al Mouwasat University hospital, the only properly equipped hospital to perform paediatric rigid bronchoscopy in Damascus. We included all cases with complete medical records of children under the age of 13 years with positive bronchoscopy findings of foreign body aspiration. The records of patients were examined, and data extracted included physical examination, CXR reports, bronchoscopy reports, and complications. Statistical package for social sciences 25.0 program for Windows was used to report frequencies, percentages, means, medians, and standard deviations. Results Of 560 children diagnosed with foreign body aspiration, the peak incidence was at the age of 1–3 years 376 (67.2%). Most patients presented with an explicit history of inhalation 453 (80.9%). The most frequent clinical findings were dyspnoea 320 (57.1%), wheezing 308 (55%), and chest retraction 209 (37.35%). Hyperinflation 260 (46.4%) followed by pulmonary infiltration 197 (35.2%) were the most common abnormal radiological findings. Seeds 273 (48.8%) were the most frequent foreign body extracted by rigid bronchoscopy. The right main bronchus 255 (40.2%) was the most frequent site of foreign body lodgement. Lobar pneumonia 16 (2.8%) was the commonest complication of foreign body aspiration. Conclusion Foreign body aspiration is a major public health problem in Syria. The child's welfare must be our paramount concern. To prevent this accident, we should address a change in raising public health awareness with regards to appropriate food and eating habits. This would limit hazardous complications.
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Affiliation(s)
- Fatema Mohsen
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Batoul Bakkar
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Sara Melhem
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Roula Altom
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Bisher Sawaf
- Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Damascus, Syria.,Faculty of Medicine, American University of Beirut Medical Centre Beirut, Lebanon.,Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Imad Alkhija
- Department of Otorhinolaryngology, Faculty of Medicine, Al Mouwasat University Hospital, Syria
| | - Louei Darjazini Nahas
- Department of Surgery Division of Otorhinolaryngology, Faculty of Medicine, Syrian Private University, Damascus, Syria
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10
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Li S, Wu L, Zhou J, Wang Y, Jin F, Chen X, Liu J, Chen Z. Interventional therapy via flexible bronchoscopy in the management of foreign body-related occlusive endobronchial granulation tissue formation in children. Pediatr Pulmonol 2021; 56:282-290. [PMID: 33104291 DOI: 10.1002/ppul.25134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Occlusive granulation tissue formation, as one of the most common sequelae of chronic foreign body aspiration, can cause tracheobronchial obstruction and delayed fixed airway stenosis necessitating interventions. The aim of this study was to explore the clinical efficacy and safety of interventional therapy via flexible bronchoscopy for treatment of granulation tissue related airway obstruction secondary to foreign body aspiration in children. METHOD Patients with long-term foreign body related granulation tissue were treated with flexible bronchoscopy therapeutic modalities, including forceps, cryotherapy, holmium laser, and balloon dilatation. Clinical efficacy was evaluated by clinical symptoms and endoscopic manifestations. RESULTS A total of eight patients with granulation tissue hyperplasia caused by foreign body in bronchus, with a median age of 29.5 (range, 18-54) months, underwent interventional therapy between January 2016 and December 2019. Four patients received forceps and CO2 cryotherapy and one patient required forceps only. The remaining three patients received holmium laser combined with CO2 cryotherapy, and one of them required additional balloon dilatation. Four cases required a second cryotherapy procedure, and one case received three cryotherapy procedures for extensive granulation tissue. The treatment efficacy was 100% without complications. CONCLUSION Interventional procedure via flexible bronchoscopy is a safe, reliable, and effective method in the management of tracheobronchial obstruction and stenosis caused by foreign body-related granulation tissue hyperplasia. It is worthy of clinical application.
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Affiliation(s)
- Shuxian Li
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.,Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Lei Wu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.,Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Junfen Zhou
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.,Department of Pediatrics, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang, China
| | - Yingshuo Wang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.,Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Fang Jin
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Xiaoyang Chen
- Department of Developmental and Behavioral, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Jinling Liu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Zhimin Chen
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
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Abstract
OBJECTIVES The functional oral intake scale (FOIS), developed for adults based on the categories of consumable food has been adapted for infants. A FOIS for children is necessary as oral motor development continues after 1 year of age. This study proposed a FOIS for children and investigated the reliability and validity of the scale. METHODS We adapted the original FOIS into a scale for children by removing 2 item levels to generate a 5-point scale. This retrospective study included 194 children ages 1 to 7 years. Their nutrition records were evaluated separately by 2 raters using the FOIS for children. Dysphagia and aspiration severity were evaluated based on the findings from a videofluoroscopic swallowing study. For children partially dependent on tube feeding, medical records were investigated to determine whether full oral feeding was accomplished within 1 year. RESULTS The inter-rater reliability of FOIS for children had 97.4% agreement (weighted kappa = 0.985, intraclass correlation coefficient = 0.994). Significant associations were identified between the FOIS for children and aspiration severity (P < 0.001, r = 0.315) and dysphagia severity (P < 0.001, r = 0.287). The rate of reaching full oral feeding within 1 year was greater (71.4% vs 30%) in children at the FOIS 3 level (tube and oral feeding in parallel) than for children at FOIS 2 (tube-dependent with minimal oral intake). CONCLUSIONS The FOIS for children showed adequate reliability and validity and could be appropriate for documenting children's eating abilities and evaluating the effectiveness of interventions.
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Zychlinsky Scharff A, Schwerk N, Baumann U, Burmester H, Carlens J, Dopfer C, Grewendorf S, Mueller C, Schütz K, Voelker M, Hansen G, Happle C, Wetzke M. An apple a day won't keep the doctor away: presentation, treatment, and outcome in pediatric apple aspirations. Pediatr Pulmonol 2020; 55:1697-1704. [PMID: 32442360 DOI: 10.1002/ppul.24768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/12/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Foreign body (FB) aspiration is a frequent and preventable source of morbidity and mortality, especially in children under 4 years of age. Few comprehensive studies exist on presentation and outcome of apple aspirations in children. METHODS In a retrospective analysis of bronchoscopy records of a tertiary medical care center from January 2007 to August 2019, we identified pediatric cases of suspected apple aspirations. RESULTS A total of 11 suspected apple aspirations were identified (observation time 12.7 years, n = 5858 bronchoscopies, n = 226 interventions due to suspected FB aspirations in total). The mean age of patients was 24 months (standard error mean, 7 months; range, 8-83 months), and 6 out of 11 cases (55%) were male. Bronchoscopy confirmed apple aspiration in n = 6/11 cases (55%). In n = 2/11 cases (18%), a bite of the apple was located in the esophagus causing significant tracheal narrowing, and in n = 3/11 cases (27%), no FB was found. In all cases of airway FB identification, extraction was successful. Hypersalivation was associated with esophageal FB location, whereas persistent cough, stridor, or dyspnea were associated with airway FB location. Outcomes ranged from complete reconstitution 1 day after bronchoscopy in most cases to hypoxemia with severe brain damage in one patient. DISCUSSION This analysis shows that apple aspirations are not entirely uncommon in children and may lead to disastrous complications. Typical signs of airway location are persistent cough, stridor or dyspnea, whereas hypersalivation may point toward an esophageal location. In each case of suspected apple aspiration, timely bronchoscopy with possible FB extraction should be performed by an experienced team.
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Affiliation(s)
- Anna Zychlinsky Scharff
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, German Center for Lung Research, Hannover, Germany
| | - Ulrich Baumann
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Helen Burmester
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Julia Carlens
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Christian Dopfer
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Simon Grewendorf
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Carsten Mueller
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Katharina Schütz
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Marc Voelker
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, German Center for Lung Research, Hannover, Germany
| | - Christine Happle
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, German Center for Lung Research, Hannover, Germany
| | - Martin Wetzke
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, German Center for Lung Research, Hannover, Germany.,Partner Site Hannover-Braunschweig, German Center for Infection Research (DZIF), Braunschweig, Germany
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Risk Management and Recommendations for the Prevention of Fatal Foreign Body Aspiration: Four Cases Aged 1.5 to 3 Years and Mini-Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134700. [PMID: 32629891 PMCID: PMC7369691 DOI: 10.3390/ijerph17134700] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022]
Abstract
(1) Background: Foreign body aspiration (FBA) is a significant public health concern among the pediatric population, and fatalities are dramatic for families. It typically involves organic foreign bodies (mainly food) aspirated by children under three years old, usually at home or school. This review aimed to focus on the preventive measures around four actual cases of fatal foreign body aspiration, emphasizing the correct execution of the Heimlich maneuver and cardiopulmonary resuscitation, supervised mealtimes, and high-risk foods. (2) Methods: Four fatal cases of foreign body aspiration in children are presented here. The children were in a free environment, such as school, home, and the countryside, and were in the presence of teachers, parents, and a grandmother who did not supervise the children adequately. A literature review was performed via the MEDLINE database using the key terms: “foreign body aspiration,” “infant choking, 1.5 to 3 years,” “food and foreign body aspiration,” “common household,” “prevention of foreign body aspiration,” “guidelines,” “recommendations,” “training of caregivers (parents, educators),” “resuscitation,” “Heimlich maneuver,” and “disengagement of the upper airways.” We focused on the prevention of foreign body aspiration. (3) Results: a complete postmortem examination was performed. In three cases, the foreign bodies were food (mozzarella cheese, pear, or raw bean), while in one case, the foreign body was a pebble. (4) Conclusions: This review aimed to discuss recent scientific literature and provide a perspective on the benefits of a dedicated approach to the management of fatal foreign body aspiration in children by caregivers who usually have no experience with the best ways of supervising children in a safe environment, especially regarding the correct execution of resuscitation maneuvers, such as the Heimlich maneuver. Recommendation updates could improve healthcare quality in a pediatric setting and reduce medico-legal implications.
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Bellocchi G, Acquaviva G, Giammona Indaco F, Eibenstein A. Foreign bodies in the pediatric age: the experience of an Italian tertiary care hospital. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:60-64. [PMID: 32073563 PMCID: PMC7947743 DOI: 10.23750/abm.v91i1-s.9260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Indexed: 11/23/2022]
Abstract
Foreign bodies in pediatric age represent an extremely frequent pathological condition and can undergo fearsome complications. Within the ENT area, foreign bodies in the pediatric age can be found in various districts such as external auditory canal, nasal passages, oral cavity, pharynx, larynx and trachea. They can be various and shape; generally, the main ones are buttons, beads, small parts of toys, caps of pens, pebbles, fragments of food bolus and others. As described in the literature, the main localizations are the external auditory canal and nasal cavities. Laryngeal and tracheal localization is infrequent but can be fatal. The aspiration of foreign bodies, mainly small parts of toys, occurs more frequently under three years age and mainly-especially in males. The experience of the ENT Department of the San Camillo-Forlanini Hospital in Rome, in the period between January 2007 and December 2018, consists a total of 1443 patients, aged between 0 and 14, who arrived in the emergency room with a foreign body diagnosis; of these, 613 (42.5%) were found with foreign body in the external auditory canal, 458 (31.7%) in nasal fossa, 298 (20.5%) in pharynx, 64 (4.4%) in oropharynx, and 10 (0.7%) in larynx and trachea. Treatment was in 1255 (87%) removal in the emergency room and home discharge, 79 (5.4%) with outpatient discharge, 40 (2.7%) need for hospitalization and surgery, 64 (4.4 %) refusal of hospitalization and 1 case (0.07%) died in the emergency room. (www.actabiomedica.it)
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Reid A, Hinton-Bayre A, Vijayasekaran S, Herbert H. Ten years of paediatric airway foreign bodies in Western Australia. Int J Pediatr Otorhinolaryngol 2020; 129:109760. [PMID: 31751807 DOI: 10.1016/j.ijporl.2019.109760] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/27/2019] [Accepted: 10/27/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whenever a paediatric airway foreign body (PAFB) is suspected, decisions may be difficult without a clearly defined or accepted treatment algorithm. History and examination are commonly non-diagnostic and the risks associated with either watchful waiting or proceeding to MLB are significant. This paper reviews a 10 year cohort of suspected PAFBs for the predictive utility of history, examination and investigations and subsequent positive findings at MLB. OBJECTIVES STUDY DESIGN: The medical records of 127 children who underwent MLB for suspected PAFB between 2007 and 2016 were examined. The data was retrospectively reviewed for epidemiological details, history, examination, radiological findings and MLB outcomes. RESULTS Sensitivity for PAFB on MLB with all three; history, examination and imaging (x-ray) positive for PAFB was 87.7%. Of the patients who were both symptom and sign positive (n = 96), chest x-ray findings did not significantly alter the chance of finding a PAFB. Chest x-ray had a low specificity (17%) in symptom and sign positive patients. Conversely, sensitivity of chest x-ray was high (88%), for symptom and sign positive patients. CONCLUSIONS For a child with both signs and symptoms, xray is unlikely to assist in decision making around suspected PAFB. When only sign or symptom is present, positive imaging may significantly increase the chance that PAFB is the cause.For patients with a low suspicion of PAFB, consideration of a CT can be a helpful means of excluding a PAFB and avoiding an unnecessary general anaesthetic in this potentially high-risk group.A greater level of public awareness is needed with regards to appropriate food types for children and the importance of eating seated and supervised in order to reduce the risk of PAFB.
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Affiliation(s)
- Allison Reid
- Perth Children's Hospital (previously Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
| | - Anton Hinton-Bayre
- Perth Children's Hospital (previously Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Shyan Vijayasekaran
- Perth Children's Hospital (previously Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Hayley Herbert
- Perth Children's Hospital (previously Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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16
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Gao YQ, Tan JL, Wang ML, Ma J, Guo JX, Lin K, Wei JJ, Wang DY, Zhang TS. How Can We Do Better? Learning From 617 Pediatric Patients With Airway Foreign Bodies Over a 2-Year Period in an Asian Population. Front Pediatr 2020; 8:578. [PMID: 33014948 PMCID: PMC7511629 DOI: 10.3389/fped.2020.00578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Foreign body (FB) in the pediatric airway is a prevailing and crucial emergency with presenting symptoms often overlapping with other common pediatric conditions. There are limited number of large cohort studies in an Asian population which demonstrate the diversity of symptoms, investigations which will aid in obtaining the diagnosis, and management. Using this large cohort, we aim to evaluate the type and location, clinical presentations and outcomes of medical management related to pediatric airway FB in an Asian society. Methods: This is a retrospective study of all airway FB treated in Kunming Children's Hospital, China from February 2016 to June 2019. Six hundred and thirty-two clinical and operative records of all airway FB were retrieved and reviewed from the hospital's central electronic medical records. A total of 617 patients were included in our study. Results: The age ranged from 4 months to 12 years (mean = 1.74 years). The duration of symptoms ranged from 1 h to 605 days, with the diagnosis established at an average 9.16 days. Almost all had multiple symptoms, most commonly cough (98.5%) followed by noisy breathing (98.2%). Majority of the FBs (95.5%) were organic and the rest inorganic. Of the organic FBs, peanut was the most common (31.6%), followed by walnut (13.3%) and sunflower seeds (9.2%). Comparatively, 80.8% of the organic FBs were retrieved incomplete while 85.7% of the inorganic FBs were completely intact. Multiple FBs were noted in 43.3% of the patients, with 2.4% of them in different locations. Conclusions: Airway FB can be easily missed with resultant delay in diagnosis. In an Asian population, walnut and sunflower/pumpkin seeds feature more prominently compared to Western populations. Sunflower seed FBs tend to present earlier and are found intact in the trachea. Rigid bronchoscopy is the most common technique used to remove such FBs and pulmonary-related complications post-operatively, though rare, are the most common adverse outcomes. Preventive strategies targeting the appropriate age group and this type of FB may be useful in an Asian population.
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Affiliation(s)
- Ying-Qin Gao
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - Jian Li Tan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Mei-Lan Wang
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - Jing Ma
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - Jia Xi Guo
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ken Lin
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - Jing-Juan Wei
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming Medical University, Kunming, China
| | - De-Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tie-Song Zhang
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
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Bradshaw J, Dayan JE, Collins SV, Josephson G. Playful Child, Dangerous Intruder: A Case of Silent Foreign Body Aspiration in a 13-Month-Old Boy. Clin Pediatr (Phila) 2019; 58:1031-1033. [PMID: 31130006 DOI: 10.1177/0009922819851265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Gary Josephson
- 3 Nemours Children's Health System, Jacksonville, FL, USA
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18
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Cheng J, Liu B, Farjat AE, Routh J. National estimations of airway foreign bodies in children in the United States, 2000 to 2009. Clin Otolaryngol 2019; 44:235-239. [PMID: 30450702 PMCID: PMC6488414 DOI: 10.1111/coa.13261] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/24/2017] [Accepted: 11/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Identify risk factors associated with airway foreign bodies in children in the United States and report observed trends over time. DATA SOURCE KID database (2000-2009). METHODS ICD-9-CM codes for airway foreign bodies were used to identify patients. Risk factors were used for univariate analysis and a multivariate model to identify any increased risk of mortality. These factors were then also trended over time. RESULTS Children with airway foreign bodies demonstrate similar risk factors as previously reported, such as male gender, age less than five years and lack of private insurance. The weighted mortality rate for paediatric inpatients with airway foreign bodies was about 2.75%. Fortunately, the rate remained relatively unchanged from 2000 to 2009. Geographically, urban hospital settings appeared to be more affected. Increased risks of mortality were noted for older age, urban hospital setting and teaching hospital status. CONCLUSIONS Our findings confirm previous findings and identified that the diagnosis of airway foreign bodies in children were associated with male gender, age <5 years, lack of private insurance and geographic location in an urban setting. Further investigation may be warranted to provide clarity on other factors found to have increased association with mortality for quality improvement.
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Affiliation(s)
- Jeffrey Cheng
- Pediatric Otolaryngology, Department of Surgery, Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC
| | - Beiyu Liu
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC
| | - Alfredo E. Farjat
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC
| | - Jonathan Routh
- Pediatric Urology, Department of Surgery, Duke University Medical Center, Durham, NC
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19
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Patel PB, Shapiro NL. Portable, non-powered, suction-generating device for management of life-threatening aerodigestive tract foreign bodies: Novel prototype and literature review. Int J Pediatr Otorhinolaryngol 2019; 118:31-35. [PMID: 30578993 DOI: 10.1016/j.ijporl.2018.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/09/2018] [Accepted: 12/09/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To present a novel approach for the emergent, pre-hospital management of life-threatening aerodigestive tract foreign body aspiration using a portable, non-powered, suction-generating device (PNSD), in the context of a literature review of emergent pre-hospital management of patients with foreign body airway obstruction. METHODS The PubMed and MEDLINE databases were comprehensively screened using broad search terms. A literature review of pre-hospital management and resuscitative techniques of foreign body airway obstruction was performed. Further, independent measurements of PNSD pressure generation were obtained. Application of a PNSD in cadaveric and simulation models were reviewed. A comparative analysis between a PNSD and other resuscitative techniques was performed. RESULTS Physiologic data from adult and pediatric human, non-human, and simulation studies show pressure generation ranging from 5.4 to 179 cm H2O using well-established resuscitative maneuvers. Laboratory testing demonstrated that a protypic PNSD demonstrated peak airway pressures of 434.23 ± 12.35 cm H2O. A simulation study of a PNSD demonstrated 94% reliability in retrieving airway foreign body, while a similar cadaveric study demonstrated 98% reliability, with both studies approaching 100% success rate after multiple attempts. Several case reports have also shown successful application of PNSD in the emergent management of airway foreign body in elderly and disabled patients. CONCLUSION PNSDs may play an important role in the emergent, non-operative, pre-hospital management of upper aerodigestive tract foreign body aspiration, particularly in settings and populations with high choking risk. Further characterization of effectiveness and safety in larger cadaveric or simulation studies mimicking physiologic conditions is indicated.
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Affiliation(s)
- Pratik B Patel
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Nina L Shapiro
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
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20
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The Pillow Project, Infant Choking, and Basic Life Support Training for Prospective Parents: A Low-Cost Intervention for Widespread Application. J Perinat Neonatal Nurs 2019; 33:260-267. [PMID: 31335856 DOI: 10.1097/jpn.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dissemination of pediatric basic life support skills, while recommended, is not done routinely for pregnant women and their partners within the maternity services. This study evaluates an e-learning program coupled with the use of a novel infant pillow mannequin to determine whether a low-cost intervention with potential for widespread application could enable training in the event of an infant choking and the provision of basic life support. A prospective cohort study with an uncontrolled pre- and posttest design was used following institutional ethical approval. A 4-week cycle of antenatal education classes in a regional Maternity Hospital in Ireland and a purposive sample of pregnant women and their partners attending the antenatal education classes were used. The following measures were assessed: (1) confidence in knowing what to do in the event of an infant choking; (2) confidence in performing infant cardiopulmonary resuscitation (CPR); (3) ability to perform the requisite skills; and (4) the perceived acceptability of the infant pillow mannequin as a means of practice. Twenty-four individuals completed a pre- and postprogram questionnaire. The e-learning program along with practice on the pillow mannequin significantly affected confidence (P < .001) in the actions to take in the event of an infant choking and in performing infant CPR. Forty-four participants used the pillow mannequin for practice and volunteered to have their skills assessed. More than 90% demonstrated correct positioning of the infant in the event of choking, correctly identified the correct ratio of chest compressions to breaths, and conducted chest compressions to the required depth. Three distinct categories of comment were identified: usefulness of the program; simplicity of the program/pillow mannequin; and accessibility for practice at home. A self-instructional e-learning program coupled with an infant pillow mannequin enables parents to learn the procedure in the event of an infant choking and to demonstrate basic life support. This low-cost intervention has the potential for widespread application within developed and developing countries.
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He S, Zuo ZL. Different anatomical sites of the foreign body injury with 2999 children during 2012-2016. Chin J Traumatol 2018; 21:333-337. [PMID: 30583981 PMCID: PMC6354173 DOI: 10.1016/j.cjtee.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/02/2018] [Accepted: 07/31/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE This study aimed to analyze the clinical characteristic of different foreign body injuries in children and offer the preventions. METHODS A retrospective study and the demographic information, injury causes, foreign body injury types and other clinical factors were recorded and analyzed. RESULTS Of the 2999 patients, 1877 (62.6%) were boys and 1122 (37.4%) were girls. The majority (72.8%, n = 2184) of the injuries were found in 1-3 years old children. The most common anatomical site was the respiratory tract (73.4%, n = 2201) followed by the digestive tract (18.6%, n = 558), the genitourinary tract (1.93%, n = 58) and other sites (6.07%, n = 182). There were 60.4% of the in-patients from rural areas and 53.2% of the patients without medical insurance, the rate of cost by medical insurance increased with age. The medians of length of hospital stay and hospitalization cost were four days and 4767.3 CNY respectively. Most of the patients had surgical treatment (90.6%, n = 2717) and 64.9% of them had the complications (n = 1946). The cure rates of the all foreign body injuries types were above 90%, especially in genitourinary tract (98.3%). CONCLUSION Different types of the foreign body injuries had dissimilar clinical characteristics. The effective prevention and control measures should be taken according to the variety of high-risk population, incidence season and foreign body injury types.
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Affiliation(s)
- Shan He
- Chongqing Medical University, Chongqing, 400014, China
| | - Ze-Lan Zuo
- Department of PICU, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chonqing, 400014, China.
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22
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Abstract
The American Academy of Pediatrics (AAP) recommends when to start first finger foods (FFFs) and what types of foods to start with, but it is unclear whether products marketed as FFF comply with these recommendations. We evaluated FFF products for compliance with AAP recommendations and product safety using 41 adult product testers, who were asked to dissolve each product in their mouth. Product characteristics, comments pertaining to product safety, and time to dissolve each product were recorded. Only 2 products met all AAP criteria, and safety concerns were raised for an additional 2 products. One product showed a large change in dissolvability after being left out of original packaging. Consumers should not assume that products marketed for infant/toddler consumption comply with AAP recommendations. Also, products left out of original packaging may change consistency, presenting a choking hazard. Additional research is warranted to guide the development of regulations surrounding labeling and marketing of these foods.
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Affiliation(s)
- Nicol Awadalla
- 1 Cohen Children's Medical Center of New York, Lake Success, NY, USA
| | - Tammy Pham
- 1 Cohen Children's Medical Center of New York, Lake Success, NY, USA
| | - Ruth Milanaik
- 1 Cohen Children's Medical Center of New York, Lake Success, NY, USA
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Wu X, Wu L, Chen Z, Zhou Y. Fatal choking in infants and children treated in a pediatric intensive care unit: A 7- year experience. Int J Pediatr Otorhinolaryngol 2018; 110:67-69. [PMID: 29859591 DOI: 10.1016/j.ijporl.2018.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/10/2018] [Accepted: 04/26/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Foreign bodies aspiration can lead to significant morbidity, few have examined in detail the deaths resulting from foreign bodies aspiration. METHODS We conducted a review of children who presented to the pediatric intensive care unit of a university hospital due to fatal foreign bodies aspiration during the period of 2010-2017. RESULT Of the 28 patients, 17 (61%) patients were male and 11 (39%) were female. The range of age was 1-63 months, with mean of 15.2 months. The common foreign bodies included milk, nuts and fruits. Majority of them had round shapes. All the patients died due to asphyxia or serious complications after foreign bodies aspiration. CONCLUSIONS Prevention and early recognition remains a critical factor to reduce the mortality of foreign bodies aspiration.
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Affiliation(s)
- Xiling Wu
- Department of Pulmonology, Child's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
| | - Lei Wu
- Department of Pulmonology, Child's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
| | - Zhimin Chen
- Department of Pulmonology, Child's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
| | - Yunlian Zhou
- Department of Pulmonology, Child's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
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24
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Aguiar RS, Esmerino EA, Rocha RS, Pimentel TC, Alvarenga VO, Freitas MQ, Silva MC, Sant'Ana AS, Silva AC, Cruz AG. Physical hazards in dairy products: Incidence in a consumer complaint website in Brazil. Food Control 2018. [DOI: 10.1016/j.foodcont.2017.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Samra S, Schroeder JW, Valika T, Billings KR. Tracheotomy for Difficult Airway Foreign Bodies in Children. Otolaryngol Head Neck Surg 2018; 158:1148-1149. [PMID: 29437526 DOI: 10.1177/0194599818758995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sheena Samra
- 1 University of Illinois at Chicago, Department of Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA
| | - James W Schroeder
- 2 Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA.,3 Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA
| | - Taher Valika
- 2 Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA
| | - Kathleen R Billings
- 2 Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA.,3 Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA
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Sjogren PP, Mills TJ, Pollak AD, Muntz HR, Meier JD, Grimmer JF. Predictors of complicated airway foreign body extraction. Laryngoscope 2017; 128:490-495. [PMID: 28815616 DOI: 10.1002/lary.26814] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 06/06/2017] [Accepted: 06/27/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate outcomes of foreign body aspiration (FBA) and to investigate surgeon and hospital volume as risk factors for a complicated course. STUDY DESIGN Retrospective case series. METHODS Children with FBA in a multihospital network were identified from January 2005 to September 2015. Demographic information, surgeon, and hospital location were reviewed. Mean operative time and hospital length of stay were recorded. Cases requiring intensive care unit admission, hospital stay greater than 24 hours, need for more than one bronchoscopy, operative time greater than 1 hour, or death were considered "complicated." RESULTS A total of 450 cases of airway foreign body extraction were performed. Patient ages ranged from 0.6 to 18.8 years, with a median age of 1.9 years. Bronchoscopy with foreign body extraction was performed by 55 different surgeons at 11 different facilities. There were one to 24 surgeons for each facility, with an average number of 5.4 surgeons per facility. A total of 88 (19.6%) cases were considered complicated, including five (1.1%) deaths. Increased rates of complications were seen with unwitnessed aspiration (P = 0.008) and hyperlucency (P < 0.001) or infiltrates (P = 0.001) on chest radiographs. No significant association was found between surgeon type or facility as related to a complicated case. CONCLUSIONS Unwitnessed aspiration events and abnormalities on chest radiograph may be associated with a more complicated course in children with FBA. This multihospital study identified a low number of procedures by many surgeons; however, surgeon and hospital volume did not significantly correlate with higher complication rates. LEVEL OF EVIDENCE 4. Laryngoscope, 128:490-495, 2018.
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Affiliation(s)
- Phayvanh P Sjogren
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Tyler J Mills
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Adrianna D Pollak
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Harlan R Muntz
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Jeremy D Meier
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - J Fredrik Grimmer
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
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Mohammad M, Saleem M, Mahseeri M, Alabdallat I, Alomari A, Za'atreh A, Qudaisat I, Shudifat A, Nasri Alzoubi M. Foreign body aspiration in children: A study of children who lived or died following aspiration. Int J Pediatr Otorhinolaryngol 2017; 98:29-31. [PMID: 28583498 DOI: 10.1016/j.ijporl.2017.04.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/16/2017] [Accepted: 04/18/2017] [Indexed: 11/29/2022]
Abstract
Foreign body aspiration (FBA) is a preventable cause of mortality and morbidity in children. We conducted a chart review of children who presented to a university hospital due to FBA in the period 1999-2014. Children were either managed with bronchoscopy for removal of the foreign body or died due to FBA. A total of 103 children were seen due to FBA including 27 deaths. The majority of children were boys and were less than 3 years old. Most aspirated foreign bodies were food-related, mainly peanuts. The majority of children presented with acute choking incidents, a smaller number presented with recurrent chest infections, and few children's choking incidents were unwitnessed. X-ray had a high rate of false negatives and bronchoscopy was the gold standard technique for assessment and management. Aspiration of foreign bodies is a preventable, life-threatening condition that calls for increased parent education and awareness.
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Affiliation(s)
- Maha Mohammad
- The University of Jordan, Department of Physiotherapy, Jordan.
| | - Mohammad Saleem
- The University of Jordan, Jordan University Hospital, Department of General Surgery, Jordan
| | - Mohamad Mahseeri
- The University of Jordan, Jordan University Hospital, Department of General Surgery, Jordan
| | - Imad Alabdallat
- The University of Jordan, Jordan University Hospital, Department of Forensic Medicine and Toxicology, Jordan
| | - Ali Alomari
- The University of Jordan, Jordan University Hospital, Department of General Surgery, Jordan
| | - Ala' Za'atreh
- The University of Jordan, Jordan University Hospital, Department of Pediatrics, Jordan
| | - Ibraheem Qudaisat
- The University of Jordan, Jordan University Hospital, Department of Anasthesia, Jordan
| | - Abdulrahman Shudifat
- The University of Jordan, Jordan University Hospital, Department of Neurosurgery, Jordan
| | - Mohammad Nasri Alzoubi
- The University of Jordan, Jordan University Hospital, Department of General Surgery, Jordan
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Cheng J, Liu B, Farjat AE, Routh J. The public health resource utilization impact of airway foreign bodies in children. Int J Pediatr Otorhinolaryngol 2017; 96:68-71. [PMID: 28390617 DOI: 10.1016/j.ijporl.2017.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/25/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Quantify the resource utilization associated with airway foreign bodies in children in the United States using a national database and report observed trends over time. STUDY TYPE Cross-sectional analysis of national inpatient database with weighted estimates. DATA SOURCE The KID database (2000-2009). METHODS ICD-9-DM codes for foreign body aspiration were used to identify patients to be included for investigation. Admission rates and charges were aggregated and compared among geographic region, location, and teaching hospital status. These factors were then also trended over time. RESULTS From 2000 to 2009, airway foreign body diagnoses in children accounted for an estimated 4000 to 5000 admissions, resulting in a mean admission rate of 6.6 per 10,000 pediatric patients annually. Charges related to airway foreign bodies in children rose from a total of $93 million to $486 million in the observed period. There is an increasing trend over time of total charges per patient. Charges appear to be higher in urban locations and teaching hospitals. CONCLUSIONS The public health and economic burden of pediatric airway foreign bodies appears to be rising. Further investigation may be helpful to examine factors that may be contributing to increasing charges and creating strategies to improve cost effectiveness, as well as why there seems to be increased resource utilization in urban locations and teaching hospitals.
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Affiliation(s)
- Jeffrey Cheng
- Pediatric Otolaryngology, Department of Surgery, Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, United States.
| | - Beiyu Liu
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
| | - Alfredo E Farjat
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
| | - Jonathan Routh
- Pediatric Urology, Department of Surgery, Duke University Medical Center, Durham, NC, United States
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Kendigelen P. The anaesthetic consideration of tracheobronchial foreign body aspiration in children. J Thorac Dis 2016; 8:3803-3807. [PMID: 28149580 DOI: 10.21037/jtd.2016.12.69] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cases of tracheobronchial foreign body aspiration are frequently encountered emergency cases of childhood; and, delays in its recognition and treatment do result in serious morbidity and mortality. Diagnosis mainly relies on taking history which should indicate what the foreign body is, when it has been aspirated and where it is located. Belated consultation can cause misdiagnosis with the mixing of the symptoms and data with those of other pathologies common to childhood and further delays in the correct diagnosis. Bronchoscopy is required for the differential diagnosis of suspected tracheobronchial foreign body aspiration in order to eliminate other common pediatric respiratory concerns. Given the shared use of the airways by the surgeon and the anaesthesiologist, bronchoscopy is a challenging procedure requiring experienced teams with an efficient method of intercommunication, and also well planning of the anaesthesia and bronchoscopy ahead of the procedures. Despite the recent popularisation of the fiberoptic brochoscopes, the rigid bronchoscopy remains to be used commonly and is regarded to provide the gold standard technique. There have been reports in the literature on the uses of inhalation and/or intravenous (IV) anaesthesia and spontaneous or controlled ventilation methods without any demonstration of the superiority of one technique over the other. The most suitable methods of anaesthesia and ventilation would be those that reduce the risks of complications, morbidity and mortality; and, preventive measures should be taken with priority against childhood cases of tracheobronchial foreign body aspiration.
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Affiliation(s)
- Pinar Kendigelen
- Department of Anesthesiology and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey
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30
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Shu L, Hu Y, Wei R. Argon Plasma Coagulation Combined with a Flexible Electronic Bronchoscope for Treating Foreign Body Granulation Tissues in Children's Deep Bronchi: Nine Case Reports. J Laparoendosc Adv Surg Tech A 2016; 26:1039-1040. [PMID: 27788023 DOI: 10.1089/lap.2016.0388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Deep bronchial obstruction in children caused by foreign bodies is a medical emergency frequently accompanied by the formation of granulation tissue in the airway mucosa, which is resected during removal of the foreign body. Argon plasma coagulation (APC), initially developed to achieve hemostasis in gastrointestinal bleeding during endoscopic procedures, is also used for interventional bronchoscopic therapies of malignant airway tumors. In this pilot study, we describe successful alternative resections of granulation tissues during foreign body removal by flexible bronchoscopy through concomitant APC applications in 9 children aged from 16 months to 4 years old.
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Affiliation(s)
- Linhua Shu
- 1 Department of Respiration, Shanghai Children's Hospital, Shanghai Jiao Tong University , Shanghai, China
| | - Yijing Hu
- 1 Department of Respiration, Shanghai Children's Hospital, Shanghai Jiao Tong University , Shanghai, China
| | - Rong Wei
- 2 Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University , Shanghai, China
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31
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Takamiya M, Niitsu H, Saigusa K, Dewa K. Pediatric autopsy case of asphyxia due to salmon egg (ikura) aspiration. Pediatr Int 2016; 58:899-901. [PMID: 27389419 DOI: 10.1111/ped.12993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/27/2016] [Accepted: 03/18/2016] [Indexed: 11/30/2022]
Abstract
Here we report an autopsy case of asphyxia due to aspiration of a salmon egg (ikura) into the airway. The patient was a 19-month-old girl. During breakfast, she put salmon eggs into her mouth, and began to walk. She slipped, fell down, and collapsed. She was pronounced dead following 2 h of resuscitation. The body was autopsied 28 h after death. The gastric contents consisted of rice, orange sections, and white salmon eggs. The lungs were deeply congested and over-inflated. In the right lung, areas of atelectasis in the upper and middle lobes were seen. A yellow salmon egg (8 mm in diameter) was found in the trachea. Although fish eggs are consumed throughout the world, reports of this sort are limited. The aspiration of fish eggs is under-acknowledged and underreported. The importance of preventive measures needs to be emphasized to parents and caregivers.
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Affiliation(s)
- Masataka Takamiya
- Department of Forensic Medicine, Iwate Medical University, Iwate, Japan.
| | - Hisae Niitsu
- Department of Forensic Medicine, Iwate Medical University, Iwate, Japan
| | - Kiyoshi Saigusa
- Department of Biology, Iwate Medical University Center For Liberal Arts And Sciences, Iwate, Japan
| | - Koji Dewa
- Department of Forensic Medicine, Iwate Medical University, Iwate, Japan
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Sink JR, Kitsko DJ, Georg MW, Winger DG, Simons JP. Predictors of Foreign Body Aspiration in Children. Otolaryngol Head Neck Surg 2016; 155:501-7. [DOI: 10.1177/0194599816644410] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 03/23/2016] [Indexed: 11/17/2022]
Abstract
Objectives To examine the sensitivity and specificity of history, physical examination, and radiologic studies as predictors of foreign body aspiration in children. Study Design Case series with chart review. Setting Tertiary care children’s hospital. Subjects and Methods Medical records were reviewed for 102 children who presented to our institution from 2006 to 2013 with suspected foreign body aspiration and who underwent endoscopy. Data included symptoms, physical examination, radiologic, and endoscopy findings. Descriptive statistics, sensitivity and specificity, and univariate and multivariable analyses were performed. Results A total of 102 patients were included (62% male). The mean age was 3.3 years (SD, 3.7). A foreign body was identified on endoscopy in 69 cases (68%). The most common presenting symptoms were cough (88%), choking/gagging (67%), and wheezing (57%). Decreased breath sounds and wheezing on examination were independently associated with increased odds of foreign body. The most common abnormal radiographic finding was air trapping (33%). The most frequent items retrieved were fragments of seeds and nuts (49%). There were no serious complications related to endoscopy. The sensitivity and specificity of any finding on history, physical examination, and imaging were 100% and 3%, 90% and 33%, 61% and 77%, respectively. Having a positive history, examination, and chest radiograph combined was 46% sensitive and 79% specific. Conclusions Patients with airway foreign bodies have varied presentations. The presence of any radiologic finding suggests that endoscopy should be performed, as a foreign body is probable. The absence of any history or physical examination finding was associated with a low likelihood of a foreign body.
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Affiliation(s)
- Jacquelyn R. Sink
- UPMC Medical Education Preliminary Year Residency Program, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania, USA
| | - Dennis J. Kitsko
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew W. Georg
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel G. Winger
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey P. Simons
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Affiliation(s)
- J.A.Y. Cichero
- School of Pharmacy, The University of Queensland; Brisbane QLD Australia
- The Wesley Hospital; Brisbane QLD Australia
- International Dysphagia Diet Standardisation Initiative; Brisbane QLD Australia
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34
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Rodríguez H, Cuestas G, Botto H, Nieto M, Cocciaglia A, Passali D, Gregori D. Complications in Children From Foreign Bodies in the Airway. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2016.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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35
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Cichero JAY. Introducing solid foods using baby-led weaning vs. spoon-feeding: A focus on oral development, nutrient intake and quality of research to bring balance to the debate. NUTR BULL 2016. [DOI: 10.1111/nbu.12191] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. A. Y. Cichero
- School of Pharmacy; The University of Queensland; Brisbane Qld Australia
- The Wesley Hospital; Brisbane Qld Australia
- International Dysphagia Diet Standardisation Initiative; Brisbane Qld Australia
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36
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Jariwala N, Kratimenos P, Eng D, Gaughan J, Koutroulis I. Foreign body injuries in children: Are the younger siblings doomed? Int J Pediatr Adolesc Med 2016; 3:7-11. [PMID: 30805461 PMCID: PMC6372414 DOI: 10.1016/j.ijpam.2015.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/07/2015] [Accepted: 12/15/2015] [Indexed: 11/17/2022]
Abstract
Background and objectives Foreign body injury (FBI) is a considerable public health issue for children. Although the relationships of FBI with age, gender, and objects of injury have been studied, the extent to which other demographic factors influence FBI is unclear. We hypothesized that the risk for FBI increases with the number of children in the household. Design and settings This was a retrospective analysis of 223 patients aged 2-10 years who presented to the emergency department of an inner-city pediatric hospital and who were found to have FBI. Patients and methods The guardians were contacted via phone to examine the associations of FBI with income, parental educational level, number of children in the household, and birth order while controlling with a matched population of 250 patients. Statistical analyses using frequencies and univariate and multivariate analyses were performed. Results For each increase in the number of children, the risk of FBI increased 1.44-fold (OR = 1.442). With each increase in the number of caregivers, the risk of a FBI decreased 33% (OR = 0.673). With each increase in income category, the risk of a FBI decreased 59% (OR = 0.413). Conclusion The results suggest that an increase in the number of children in a household is associated with a greater risk of FBI.
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Affiliation(s)
- Neha Jariwala
- Dept. of Emergency Medicine, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Panagiotis Kratimenos
- Dept. of Neonatal–Perinatal Medicine, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, United States
| | - David Eng
- Dept. of Emergency Medicine, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, United States
| | - John Gaughan
- Temple University School of Medicine, Biostatistics Consulting Center, Philadelphia, PA, United States
| | - Ioannis Koutroulis
- Dept. of Emergency Medicine, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, United States
- Corresponding author. Department of Emergency Medicine, St. Christopher's Hospital for Children, 160 East Erie Ave., Philadelphia, PA 19107, USA. Tel.: +1 215 427 5000.
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Abstract
Esophageal and aspirated foreign bodies have important clinical significance, and both should be considered carefully when the history or physical examination findings raise sufficient suspicion. The published evidence regarding the diagnosis and management of foreign body ingestion or aspiration is weighted disproportionately with observational studies, case controls, expert opinion, and systematic reviews. Most of the publications would receive a categorization of C (observational studies including case-control and cohort design) and D (expert opinion, case reports, and clinical reasoning). One of the few prospective studies examining the diagnostic evaluation of foreign body aspiration in children could be considered level B evidence (randomized clinical trials, systematic reviews, or diagnostic studies with minor limitations). This study found that the medical history is the most important predictive part of the evaluation. There is evidence for considering bronchoscopy if there is significant history suggestive of foreign body aspiration, even in the setting of normal physical examination findings. (28). Most ingested foreign bodies spontaneously pass without incident. However, special attention should be paid to objects in the esophagus as well as to batteries and magnets. Based on a systematic review of the literature (level B evidence) and the potential for rapid and life-threatening damage, batteries in the esophagus should be removed immediately. (10) Other objects, such as coins, may be observed for passage in an asymptomatic patient. In addition, given the high risk of significant complications, ingestion of high-powered magnets should be quickly and carefully evaluated. Although single magnets are likely to pass without complication, multiple magnets or magnets ingested with other metal objects can cause significant damage and should be removed if there is any concern for mural entrapment, bowel perforation, or failure to progress. (10)(16)(17)(18)(19). Lastly, another systematic review of the literature (level B evidence) about the aspiration of food objects in children suggests that this is a significant public health concern with potentially devastating consequences. Despite clear legislation and regulation by the Consumer Product Safety Commission regarding toys, there is no similar regulation of high-risk foods. The data suggest that there is opportunity for improvement in legislation about the production and packaging of high-risk items as well as in the education of caregivers. (22)
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Affiliation(s)
- S Sarah Green
- Pediatrics, Oregon Health & Science University, Portland, OR
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38
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Rodríguez H, Cuestas G, Botto H, Nieto M, Cocciaglia A, Passali D, Gregori D. Complications in children from foreign bodies in the airway. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 67:93-101. [PMID: 25857247 DOI: 10.1016/j.otorri.2015.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/23/2014] [Accepted: 01/14/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Foreign body aspiration in childhood is a common and potentially serious problem. Complications may be the result of the aspiration episode itself, delayed diagnosis or treatment. We describe our experience in a paediatric hospital in Argentina. METHODS We retrospectively evaluated 56 patients with complications due to foreign body aspiration recorded in the Susy Safe Project between January 2010 and November 2013. The clinical variables analysed were sex, age at time of aspiration, foreign body location and type, time elapsed from the event until object removal, extraction technique, complications, need for hospitalisation and circumstances of the event. RESULTS 58.9% of the cases described occurred in males, with high presence of adults (76.8%) at the time of aspiration. The incidence was slightly higher in children older than 3 years. In 37 cases (66.1%), the foreign body was located in bronchus; sunflower seeds and ballpoint caps were the most common foreign objects. Only in 10 cases (17.9%) was the object extracted within 24h of the event. The most common complications were pneumonia (18 cases), granuloma (15 cases) and mucosal erosion (9 cases). Hospitalisation was necessary for 41 patients. CONCLUSION Early diagnosis and immediate control through specialised teams are essential to ensure proper treatment, usually endoscopic, without risk of complications.
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Affiliation(s)
- Hugo Rodríguez
- Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Giselle Cuestas
- Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
| | - Hugo Botto
- Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Mary Nieto
- Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Alejandro Cocciaglia
- Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Desiderio Passali
- Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Dario Gregori
- Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Kim IA, Shapiro N, Bhattacharyya N. The national cost burden of bronchial foreign body aspiration in children. Laryngoscope 2014; 125:1221-4. [DOI: 10.1002/lary.25002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Irene A. Kim
- Otolaryngology-Head & Neck Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Nina Shapiro
- Otolaryngology-Head & Neck Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Neil Bhattacharyya
- Department of Otology & Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
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