1
|
Paladin I, Mizdrak I, Gabelica M, Golec Parčina N, Mimica I, Batinović F. Foreign Bodies in Pediatric Otorhinolaryngology: A Review. Pediatr Rep 2024; 16:504-518. [PMID: 38921707 PMCID: PMC11207020 DOI: 10.3390/pediatric16020042] [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: 04/09/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
Foreign bodies (FBs) in pediatric otorhinolaryngology represent up to 10% of cases in emergency departments (ED) and are primarily present in children under five years old. They are probably the result of children's curiosity and tendency to explore the environment. Aural and nasal FBs are the most common and accessible, and the removal methods differ depending on the exact location and type of FB, which can be organic or inorganic. A fish bone stuck in one of the palatine tonsils is the most common pharyngeal FB. Laryngopharyngeal FBs can obstruct the upper respiratory tract and thus become acutely life-threatening, requiring an urgent response. Aspiration of FBs is common in children between 1 and 4 years old. A history of coughing and choking is an indication of diagnostic and therapeutic methods to rule out or confirm a tracheobronchial FB. Regardless of the availability of radiological diagnostics, rigid bronchoscopy is the diagnostic and therapeutic method of choice in symptomatic cases. Radiological diagnostics are more significant in treating esophageal FBs since most are radiopaque. Flexible or rigid esophagoscopy is a successful method of removal. A delayed diagnosis, as with tracheobronchial FBs, can lead to fatal consequences.
Collapse
Affiliation(s)
- Ivan Paladin
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Ivan Mizdrak
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Mirko Gabelica
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Nikolina Golec Parčina
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Ivan Mimica
- Department of ENT, General Hospital Sibenik, 22000 Sibenik, Croatia;
| | - Franko Batinović
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Sultan TA, van As AB. Review of tracheobronchial foreign body aspiration in the South African paediatric age group. J Thorac Dis 2016; 8:3787-3796. [PMID: 28149578 DOI: 10.21037/jtd.2016.12.90] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Children, and in particular young children under the age of three, are the most vulnerable for aspiration and ingestion of foreign bodies (FBs). The Red Cross War Memorial Children's Hospital in Cape Town is the only children's hospital in South Africa and is unique in having a dedicated trauma unit for children under the age of 13 as part of its institution. Core activities of Childsafe South Africa (CSA), located at the hospital, are data accumulation and interpretation, development of educational programmes, health inculcation and advising in legislation involving child health. To achieve this task, CSA works in close co-operation with government, industry, non-governmental and community predicated organisations, community groups and individuals. A database of all children treated for trauma at CSA has been maintained since 1991; it currently contains detailed information of over 170,000 injuries in children under the age of 13. This review consists of a literature review combined with data from our database and aims to provide information on our experiences with tracheobronchial aspiration of FBs in children.
Collapse
Affiliation(s)
- Tamer Ali Sultan
- Trauma Unit, Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa;; Paediatric Surgery Unit, Department of General Surgery, Menoufia University, Shebeen El-Kom, Egypt
| | - Arjan Bastiaan van As
- Trauma Unit, Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
Patel A, Schmidt A, Jackson MA. Visual Diagnosis: 20-month-old Boy With a One-Day History of Fever and Cough. Pediatr Rev 2015; 36:e22-5. [PMID: 26133310 DOI: 10.1542/pir.36-7-e22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Anik Patel
- Department of Pediatrics, Children's Mercy Hospital & Clinics, Kansas City, MO
| | - Angela Schmidt
- Department of Pediatrics, Children's Mercy Hospital & Clinics, Kansas City, MO
| | - Mary Anne Jackson
- Division of Infectious Diseases, Children's Mercy Hospital & Clinics, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| |
Collapse
|
6
|
Hegde SV, Hui PK, Lee EY. Tracheobronchial Foreign Bodies in Children: Imaging Assessment. Semin Ultrasound CT MR 2015; 36:8-20. [DOI: 10.1053/j.sult.2014.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
7
|
Aggarwal SK, Sinha SK, Ratan SK, Dhua A, Sethi GR. Complications of Long-Standing Foreign Body in the Airway and Their Outcomes After Endoscopic Management: An Experience of 20 Cases. J Laparoendosc Adv Surg Tech A 2015; 25:81-7. [DOI: 10.1089/lap.2014.0354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Satish Kumar Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Shandip Kumar Sinha
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Anjan Dhua
- Department of Pediatric Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Gulshan Rai Sethi
- Department of Paediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| |
Collapse
|
8
|
Real-time video-assisted retrieval of airway foreign body in very young pediatric patients. Clin Exp Otorhinolaryngol 2014; 7:329-33. [PMID: 25436055 PMCID: PMC4240493 DOI: 10.3342/ceo.2014.7.4.329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/21/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022] Open
Abstract
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.
Collapse
|
9
|
Cheek JA, Egerton-Warburton D. Dangers of eating vegetables: contralateral perfusion deficit with an inhaled foreign body. Emerg Med Australas 2014; 26:411-2. [PMID: 24934961 DOI: 10.1111/1742-6723.12254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- John A Cheek
- Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia; Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | |
Collapse
|
10
|
Logistic regression analysis of risk factors for prolonged pulmonary recovery in children from aspirated foreign body. Int J Pediatr Otorhinolaryngol 2013; 77:1677-82. [PMID: 23962765 DOI: 10.1016/j.ijporl.2013.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Foreign body aspiration is a life-threatening emergency for children. Fried chicken is commonly available all over the world, but no cases have previously been reported addressing this food as a tracheobronchial foreign body. We report an extremely rare case of tracheobronchial aspiration of fried chicken complicated by severe bronchitis and postoperative atelectasis. To clarify predisposing factors related to bronchopulmonary complications, we also reviewed paediatric cases of tracheobronchial foreign bodies treated in our department over the past 14 years. METHODS We retrospectively reviewed a total of 77 cases of tracheobronchial foreign bodies from 1988 to 2011. The main outcome measure was duration of hospitalisation, reflecting postoperative therapy. Logistic regression analyses were conducted to determine risk factors for longer hospitalisation. RESULTS Age, sex, and interval between the aspiration episode and bronchoscopy were not significantly associated with longer hospitalisation. Regarding kinds of foreign bodies, higher rates of longer hospitalisation were noted for patients who had aspirated peanut or animal material, as compared to patients who had aspirated non-organic material (odds ratio, 5.80; 95% confidence interval, 1.12-30.43). CONCLUSIONS In terms of predicting the risk of pulmonary complications, the type of foreign body aspirated offers a more meaningful factor than the interval between aspiration and operation. Specifically, peanuts or animal material containing oils appear to be associated with a more prolonged pulmonary recovery even after retrieval of the foreign body.
Collapse
|
11
|
Gang W, Zhengxia P, Hongbo L, Yonggang L, Jiangtao D, Shengde W, Chun W. Diagnosis and treatment of tracheobronchial foreign bodies in 1024 children. J Pediatr Surg 2012; 47:2004-10. [PMID: 23163990 DOI: 10.1016/j.jpedsurg.2012.07.036] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 07/11/2012] [Accepted: 07/11/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study sought to summarize the experience of diagnosis and treatment of tracheobronchial foreign bodies in children to effectively reduce complications and mortality. METHODS The medical records of 1024 pediatric patients admitted to our hospital from January 1997 to September 2011 and diagnosed with clinically suspected tracheobronchial foreign body aspiration were retrospectively analyzed. RESULTS Of the 1024 children patients, 674 were boys (65.8%) and 350 girls (34.2%). Two died of respiratory and circulatory failure (foreign bodies detected upon bronchoscopy but not retrieved) before surgery, 65 patients underwent direct bronchoscopic removal of foreign bodies due to their critical status, and 957 received chest radiographs and chest fluoroscopy or multidetector spiral computed tomographic scans (941 positive). Foreign bodies were expectorated before surgery in 3 cases. There were 953 cases of bronchoscopically proven airway foreign body aspiration, with a diagnostic accuracy of 94.5%. Ninety-eight foreign bodies were lodged in the main bronchus and/or bilateral bronchi, 506 in the right main bronchus, and 349 in the left main bronchus. Atelectasis was noted in 42 patients, including 11 with pulmonary consolidation, whose lungs were re-expanded by endobronchial lavage and sputum aspiration. In 3 patients with bronchiectasis, conservative treatment following foreign body removal was followed by no improvement, and pulmonary lobectomy was performed. Foreign bodies were successfully extracted at the first bronchoscopic attempt in 948 cases, accounting for 99.7% of the total. However, 3 patients had to undergo another bronchoscopy to remove the foreign bodies. The most common types of foreign bodies were peanuts, melon seeds, and beans. CONCLUSIONS Timely accurate diagnosis and treatment of tracheobronchial foreign bodies in children can avoid delay in treatment and effectively reduce complications and mortality.
Collapse
Affiliation(s)
- Wang Gang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | | | | | | | | | | | | |
Collapse
|
12
|
Foltran F, Ballali S, Passali FM, Kern E, Morra B, Passali GC, Berchialla P, Lauriello M, Gregori D. Foreign bodies in the airways: a meta-analysis of published papers. Int J Pediatr Otorhinolaryngol 2012; 76 Suppl 1:S12-9. [PMID: 22333317 DOI: 10.1016/j.ijporl.2012.02.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Very recently, some attempts have been made to start a systematic collection of foreign bodies (FB) in view of using them to characterize the risk of chocking in terms of size, shape and consistency of the FB. However, most of the epidemiologic evidence on foreign bodies in children comes from single-center retrospective studies, without any systematic geographical and temporal coverage. This paper is aimed at providing an estimate of the distribution of foreign body's injuries in children according to gender, age, type of FB, site of obstruction, clinical presentation, diagnostic/therapeutic procedures, complications, as emerging from a meta-analytic review of published papers. METHODS A free text search on PubMed database ((foreign bodies) OR (foreign body)) AND ((aspiration) OR (airways) OR (tracheobronchial) OR (nasal) OR (inhalation) OR (obstruction) OR (choking) OR (inhaled) OR (aspirations) OR (nose) OR (throat) OR (asphyxiation)) AND ((children) OR (child)) finalized to identify all English written articles referring to foreign body inhalation over a 30 years period (1978-2008) was performed. The target of the analysis has been defined as the proportion of injuries as reported in the studies, stratified according to children demographic characteristics, type of FB, site of obstruction. The pooled proportions of FB were calculated using the DerSimonian and Laird approach. RESULTS 1699 papers were retrieved and 1063 were judged pertinent; 214 English written case series were identified, among them 174 articles were available and have been included in the analysis. Airway foreign body most commonly occurs in young children, almost 20% of children who have inhaled foreign bodies being between 0 and 3 years of age. Organic FB, particularly nuts, are the most documented objects while, among inorganic FBs, the greatest pooled proportion has been recorded for magnets, which can be particularly destructive in each location. Non specific symptoms or a complete absence of symptoms are not unusual, justifying mistaken or delayed diagnosis. Acute and chronic complications seem to occur in almost 15% of patients. CONCLUSIONS Even if an enormous heterogeneity among primary studies seems to exist and even if the absence of variables standardized definitions across case series, including class age definition and symptoms and signs descriptions, seriously impairs studies comparability, our results testify the relevant morbidity associated with foreign body inhalation in children, stressing the importance of preventive measures.
Collapse
Affiliation(s)
- Francesca Foltran
- Laboratory of Epidemiological Methods and Biostatistics, Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Foreign body aspiration and language spoken at home: 10-year review. The Journal of Laryngology & Otology 2011; 125:719-23. [PMID: 21535907 DOI: 10.1017/s0022215111000727] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To review foreign body aspiration cases encountered over a 10-year period in a tertiary paediatric hospital, and to assess correlation between foreign body type and language spoken at home. STUDY DESIGN AND METHOD Retrospective chart review of all children undergoing direct laryngobronchoscopy for foreign body aspiration over a 10-year period. Age, sex, foreign body type, complications, hospital stay and home language were analysed. RESULTS At direct laryngobronchoscopy, 132 children had foreign body aspiration (male:female ratio 1.31:1; mean age 32 months (2.67 years)). Mean hospital stay was 2.0 days. Foreign bodies most commonly comprised food matter (53/132; 40.1 per cent), followed by non-food matter (44/132; 33.33 per cent), a negative endoscopy (11/132; 8.33 per cent) and unknown composition (24/132; 18.2 per cent). Most parents spoke English (92/132, 69.7 per cent; vs non-English-speaking 40/132, 30.3 per cent), but non-English-speaking patients had disproportionately more food foreign bodies, and significantly more nut aspirations (p = 0.0065). Results constitute level 2b evidence. CONCLUSION Patients from non-English speaking backgrounds had a significantly higher incidence of food (particularly nut) aspiration. Awareness-raising and public education is needed in relevant communities to prevent certain foods, particularly nuts, being given to children too young to chew and swallow them adequately.
Collapse
|
14
|
Fidkowski CW, Zheng H, Firth PG. The anesthetic considerations of tracheobronchial foreign bodies in children: a literature review of 12,979 cases. Anesth Analg 2010; 111:1016-25. [PMID: 20802055 DOI: 10.1213/ane.0b013e3181ef3e9c] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Asphyxiation by an inhaled foreign body is a leading cause of accidental death among children younger than 4 years. We analyzed the recent epidemiology of foreign body aspiration and reviewed the current trends in diagnosis and management. In this article, we discuss anesthetic management of bronchoscopy to remove objects. The reviewed articles total 12,979 pediatric bronchoscopies. Most aspirated foreign bodies are organic materials (81%, confidence interval [CI] = 77%-86%), nuts and seeds being the most common. The majority of foreign bodies (88%, CI = 85%-91%) lodge in the bronchial tree, with the remainder catching in the larynx or trachea. The incidence of right-sided foreign bodies (52%, CI = 48%-55%) is higher than that of left-sided foreign bodies (33%, CI = 30%-37%). A small number of objects fragment and lodge in different parts of the airways. Only 11% (CI = 8%-16%) of the foreign bodies were radio-opaque on radiograph, with chest radiographs being normal in 17% of children (CI = 13%-22%). Although rigid bronchoscopy is the traditional diagnostic "gold standard," the use of computerized tomography, virtual bronchoscopy, and flexible bronchoscopy is increasing. Reported mortality during bronchoscopy is 0.42%. Although asphyxia at presentation or initial emergency bronchoscopy causes some deaths, hypoxic cardiac arrest during retrieval of the object, bronchial rupture, and unspecified intraoperative complications in previously stable patients constitute the majority of in-hospital fatalities. Major complications include severe laryngeal edema or bronchospasm requiring tracheotomy or reintubation, pneumothorax, pneumomediastinum, cardiac arrest, tracheal or bronchial laceration, and hypoxic brain damage (0.96%). Aspiration of gastric contents is not reported. Preoperative assessment should determine where the aspirated foreign body has lodged, what was aspirated, and when the aspiration occurred ("what, where, when"). The choices of inhaled or IV induction, spontaneous or controlled ventilation, and inhaled or IV maintenance may be individualized to the circumstances. Although several anesthetic techniques are effective for managing children with foreign body aspiration, there is no consensus from the literature as to which technique is optimal. An induction that maintains spontaneous ventilation is commonly practiced to minimize the risk of converting a partial proximal obstruction to a complete obstruction. Controlled ventilation combined with IV drugs and paralysis allows for suitable rigid bronchoscopy conditions and a consistent level of anesthesia. Close communication between the anesthesiologist, bronchoscopist, and assistants is essential.
Collapse
Affiliation(s)
- Christina W Fidkowski
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | |
Collapse
|
15
|
Roh JL, Hong SJ. Lung recovery after rigid bronchoscopic removal of tracheobronchial foreign bodies in children. Int J Pediatr Otorhinolaryngol 2008; 72:635-41. [PMID: 18295351 DOI: 10.1016/j.ijporl.2008.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 01/15/2008] [Accepted: 01/15/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Foreign body (FB) aspiration affects lung function and often results in pulmonary complications. We have assessed the clinical and radiological predictors of delayed lung recovery after rigid bronchoscopic removal of airway FBs. METHODS The demographic data, clinical presentations, treatment profiles, pre- and post-treatment chest radiographs, and treatment outcomes were reviewed retrospectively in 104 pediatric patients who underwent removal of tracheobronchial FBs by rigid bronchoscopy. The clinical and radiological factors predicting delayed (>or=5 days) lung recovery time were statistically analyzed by logistic regression. RESULTS Preoperative chest radiographs showed infiltrates consistent with inflammation in 21 patients (20.2%). Successful bronchoscopic removal of all FB fragments was achieved in 100 patients (96.2%). Immediate postoperative aggravation was observed in 10 patients (9.6%). Mean post-treatment pulmonary recovery was 3.8 days. On univariate and multivariate analyses, preoperative inflammation, immediate postoperative aggravation, and unsuccessful removal of airway FBs were significant predictors for delayed lung recovery. The preoperative inflammatory and immediate postoperative chest radiologic findings were significantly correlated (p<0.001). CONCLUSIONS Delayed lung recovery after rigid bronchoscopic removal of tracheobronchial FBs can be predicted by FB-induced inflammatory chest radiologic findings and the unsuccessful or complicated removal of airway FBs.
Collapse
Affiliation(s)
- Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
| | | |
Collapse
|