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Moola A, Verwey C, Mabaso T, Mopeli K, Withers A, Loveland J, Patel N, Dangor Z. Tracheobronchial foreign body aspiration in children in Soweto, South Africa: A retrospective descriptive study. Afr J Thorac Crit Care Med 2024; 30:e1145. [PMID: 39171156 PMCID: PMC11334892 DOI: 10.7196/ajtccm.2024.v30i2.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/25/2024] [Indexed: 08/23/2024] Open
Abstract
Background Airway foreign bodies are a common cause of accidental death in children. Tracheobronchial foreign body aspiration (FBA) can result in severe immediate and long-term complications if the foreign body is not identified and removed. Little is known about the burden of tracheobronchial FBA in the Soweto area, south of Johannesburg, South Africa. Objectives. To describe the burden and clinical characteristics of tracheobronchial FBA in hospitalised children in a tertiary-level hospital in Johannesburg. Methods This was a retrospective, single-centre, descriptive study of children aged <10 years who presented to Chris Hani Baragwanath Academic Hospital from 1 January 2011 to 31 December 2020. Children with FBA were identified from the paediatric pulmonology and paediatric surgery databases using the relevant International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), codes (T17.4 and T17.5). Clinical and radiological data were extracted from medical records and the databases. Results Forty-seven children with FBA were identified during the study period. Overall, the incidence of FBA among children aged <10 years of age was 1.42 per 100 000 person-years (95.0% confidence interval 1.04 - 1.88). FBA occurred more commonly in males (66.0%; n=31), and the mean (standard deviation) age at presentation was 68 (28.2) months. Most of the children (42.6%) were in the 7 - <10-year age group, followed by the 5 - <7-year age group (27.7%). Chronic respiratory symptoms were reported in one-third of the children, and a history of witnessed FBA was reported in only 59.6% of cases. Inorganic foreign bodies (n=29; 61.7%) were aspirated more commonly than organic foreign bodies; these included metal objects such as pins or springs (21.3%), toy parts (17.0%), pen or pencil lids/stoppers (12.8%) and plastic objects (6.4%). Conclusion Our study highlights the fact that tracheobronchial FBA is prevalent in school-aged children, and public safety campaigns targeted at this age group are warranted. Furthermore, to prevent sequelae, a high index of suspicion in required in children with respiratory symptoms that fail to respond to appropriate therapy. Study synopsis What the study adds. Our study demonstrated that tracheobronchial foreign body aspiration (FBA) was most prevalent in school-aged children (7 - <10 years of age), which is in contrast to studies that have reported a high prevalence in children aged <3 years. Chronic respiratory symptoms were reported in only a third of the children, and a history of witnessed FBA was reported in only 59.6%. Chest radiographs were normal in a high proportion of cases in which a chest radiograph was done (56.3%). Inorganic foreign bodies were aspirated more commonly than organic foreign bodies.Implications of the findings. Public safety campaigns should be targeted at school-aged children in Soweto, South Africa. Clinicians should investigate children with respiratory symptoms suggestive of FBA, even if a history is not forthcoming. Furthermore, to prevent long-term respiratory sequelae, a high index of suspicion in required in children with respiratory symptoms that fail to respond to appropriate therapy.
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Affiliation(s)
- A Moola
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Anaesthesia, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Verwey
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa
| | - T Mabaso
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - K Mopeli
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A Withers
- Department of Paediatric Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - J Loveland
- Department of Paediatric Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Patel
- Department of Paediatric Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Z Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa
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Wang Q, Kong X, Wang G, Dai J, Li Y, Wu C, Pan Z, He L, Li H. A real-world study of foreign body aspiration in children with 4227 cases in Western China. Sci Rep 2024; 14:15251. [PMID: 38956182 PMCID: PMC11220051 DOI: 10.1038/s41598-024-65876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
The early diagnosis and treatment of foreign body aspiration (FBA) can significantly improve the overall prognosis of children. There are significant differences in the epidemiology and clinical characteristics of FBA in different regions. Therefore, we conducted a real-world study in the western region of China with over 4000 patients. The aim of this study was to improve the understanding of FBA in terms of its types, the specific months of its occurrence, and the distribution of primary caregiver characteristics in western China. We collected the clinical and epidemiological data of children who were diagnosed with FBA in our hospital over the past 20 years through a big data centre. We matched the data of healthy children who underwent routine physical examinations at the paediatric health clinic during the same period to analyse the differences in the data of actual guardians. A total of 4227 patients from five provinces were included in this study. Foreign bodies were removed by rigid bronchoscopy in 99.4% (4202/4227) of patients, with a median age of 19 months and a median surgical duration 16 min. January was the most common month of onset for 1725 patients, followed by February, with 1027 patients. The most common types of foreign objects were melon peanuts, seeds and walnuts, accounting for 47.2%, 15.3%, and 10.2%, respectively. In the FBA group, the proportion of grandparents who were primary caregivers was 70.33% (2973/4227), which was significantly greater than the 63.05% in the healthy group (2665/4227) (P < 0.01). FBA most commonly occurs in January and February. More than 60% of FBAs occur between the ages of 1 and 2 years, and the incidence of FBA may be greater in children who are cared for by grandparents. A rigid bronchoscope can be used to remove most aspirated foreign bodies in a median of 16 min.
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Affiliation(s)
- Quan Wang
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Children's Hospital of Chongqing Medical University, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
| | - Xiangpan Kong
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Wang
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Children's Hospital of Chongqing Medical University, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Children's Hospital of Chongqing Medical University, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Children's Hospital of Chongqing Medical University, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Children's Hospital of Chongqing Medical University, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Children's Hospital of Chongqing Medical University, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China
| | - Ling He
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders; International Science and Technology Cooperation Base of Child Development and Critical Disorders; National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Children's Hospital of Chongqing Medical University, No.136 Zhongshan Second Road, Yuzhong District, Chongqing, 400014, China.
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Wang M, Ren R, Xu Y, Wang T, Liang X, Li S. Oxidative stress in the alveolar lavage fluid of children with Mycoplasma pneumoniae pneumonia. Pediatr Pulmonol 2024. [PMID: 39031860 DOI: 10.1002/ppul.27120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/12/2024] [Accepted: 05/30/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE To investigate the correlation between oxidative stress in the bronchoalveolar lavage fluid (BALF) of children with Mycoplasma pneumoniae pneumonia (MPP) and the clinical characteristics of severe MPP (SMPP) and refractory MPP (RMPP). METHODS Clinical and BALF-related data were collected from 83 patients with MPP, of which 29 had SMPP and 54 had general MPP (GMPP); 37 patients were in the RMPP group and 46 in the non-RMPP group. The levels of malondialdehyde (MDA) and advanced oxidation protein products (AOPP) as well as the activity levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) in BALF were detected. Logistic regression analyses were performed on MDA, AOPP, SOD, GSH-PX, gender, heat peak, neutrophil percentage, C-reactive protein, lactate dehydrogenase, d-dimer, lung consolidation, sputum embolus, and pleural effusion. RESULTS The levels of MDA and AOPP in the BALF of the MPP group were significantly higher than those in the control group (p < .05), whereas SOD and GSH-PX levels were lower than those in the control group (p < .05). The BALF AOPP levels in the RMPP group were higher than those in the non-RMPP group, and the SOD and GSH-PX levels in the BALF were lower than those in the non-RMPP group; the difference was statistically significant (p < .05). The levels of MDA and AOPP in the BALF of children in the SMPP group were higher than those in the GMPP group, and the levels of SOD and GSH-PX were lower than those in the GMPP group, with statistically significant differences (p < .05). The C-index of the logistic regression model was 0.960 (95% confidence interval 0.958-0.963), which indicates that the model has good predictive ability. CONCLUSION Advanced oxidation protein products may be a marker for predicting the conditions of SMPP and RMPP, and the prediction model can assess the risk of progression in children to RMPP, which is conducive to clinical diagnosis and treatment.
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Affiliation(s)
- Mengzhu Wang
- Children's Intensive Care Unit, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Ruijuan Ren
- Children's Intensive Care Unit, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Yuping Xu
- Children's Intensive Care Unit, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Tuanjie Wang
- Children's Intensive Care Unit, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Xiaojun Liang
- Children's Intensive Care Unit, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Shujun Li
- Children's Intensive Care Unit, the First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
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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.
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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.)
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Xu LQ, Liu Q, Zeng M, Yan HZ, Hu N, Zhang QX, Guo Q, Guo JL, Zhang J. A pediatric patient with bilateral tracheobronchial foreign body successfully treated using surgical intervention with extracorporeal circulation: case report and literature review. Front Pediatr 2024; 12:1406195. [PMID: 38933495 PMCID: PMC11199879 DOI: 10.3389/fped.2024.1406195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Unilateral Tracheobronchial foreign body (TFB) present a common clinical disease, whereas bilateral TFB is a rare and acute condition associated with high mortality rates. This case study discusses a pediatric patient hospitalized due to respiratory distress following accidental ingestion of peanut kernels. A plain chest CT scan revealed obstructive emphysema in the right main bronchus and a foreign body at the opening of the left main bronchus. Surgical removal of the bilateral TFB under extracorporeal circulation resulted in a successful postoperative recovery, leading to discharge on the 9th day. A comprehensive literature search was conducted across databases including PubMed, Web of Science, EMBASE, Cochrane Library, and CNKI, spanning publications from January 2014 to October 2023, utilizing keywords "bronchial foreign body" and "Peanut". After deduplication and relevance screening, 9 pertinent literature sources were included. The objective of this study is to enhance clinical practitioners' understanding of TFB management and improve diagnostic and treatment capabilities through analysis of age of onset, clinical manifestations, diagnosis, and treatment approaches in critically ill pediatric patients.
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Affiliation(s)
| | | | | | | | | | | | - Qiang Guo
- Department of Cardiothoracic Surgery, Taihe Hospital, Hubei University of Medical, Shiyan, China
| | - Jia-Long Guo
- Department of Cardiothoracic Surgery, Taihe Hospital, Hubei University of Medical, Shiyan, China
| | - Jun Zhang
- Department of Cardiothoracic Surgery, Taihe Hospital, Hubei University of Medical, Shiyan, China
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Sautin A, Marakhouski K, Pataleta A, Sanfirau K. Flexible bronchoscopy for foreign body aspiration in children: A single-centre experience. World J Clin Pediatr 2024; 13:91275. [PMID: 38947998 PMCID: PMC11212757 DOI: 10.5409/wjcp.v13.i2.91275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/21/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The technological evolution of bronchoscopy has led to the widespread adoption of flexible techniques and their use for both diagnostic and therapeutic purposes. Currently, there is an active debate regarding the comparative efficacy and safety of rigid vs flexible bronchoscopy in the treatment of foreign body aspiration. AIM To evaluate our experience with tracheobronchial foreign body extraction using flexible bronchoscopy and provide a literature overview. METHODS This was a single-centre retrospective study. Twenty-four patients were enrolled between January 2017 and January 2023. Medical records of patients aged below 18 years who were admitted to authors' affiliated institution with a suspected diagnosis of foreign body aspiration were collected from hospital's database to Microsoft Excel 2019. Data were analysed using MedCalc Statistical Software. RESULTS Patient ages varied from 9 months to 11 years. The median age was 23.5 months, 95% confidence interval (CI) 19.49-44.77. We observed age clustering in children with foreign body aspiration at our institution with three age subgroups: (1) 0-25 months; (2) 40-60 months; and (3) 120-140 months. We expectancy of an organic tracheobronchial foreign body was significantly higher in 0-25 months subgroup than that in older ones when subgroups 40-60 and 120-140 months were combined together (odds ratio = 10.0, 95%CI: 1.44-29.26, P = 0.0197). Successful foreign body extraction was performed in all cases. Conversion to a rigid bronchoscope was not required in any of the cases. No major complications (massive bleeding, tracheobronchial tree perforation, or asphyxia) were observed. CONCLUSION Flexible bronchoscopy is an effective and safe method for tracheobronchial foreign body extraction in children.
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Affiliation(s)
- Aleh Sautin
- Diagnostic Division, Republican Scientific and Practical Centre of Paediatric Surgery, Minsk 220013, Belarus
| | - Kirjl Marakhouski
- Diagnostic Division, Republican Scientific and Practical Centre of Paediatric Surgery, Minsk 220013, Belarus
| | - Aleh Pataleta
- Diagnostic Division, Republican Scientific and Practical Centre of Paediatric Surgery, Minsk 220013, Belarus
| | - Kirill Sanfirau
- Diagnostic Division, Republican Scientific and Practical Centre of Paediatric Surgery, Minsk 220013, Belarus
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Jangan A, Watts E, Pankhania M. Coin-cidence? Have cashless payments reduced the incidence of upper aerodigestive foreign body insertion? A study of UK Hospital Episode Statistics. Ann R Coll Surg Engl 2024. [PMID: 38836371 DOI: 10.1308/rcsann.2024.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVES Insertions of nasal and oral foreign bodies (FB) are common presentations in the emergency department, with coins frequently implicated among paediatric populations. Contactless payments were first introduced in the UK in 2007, and cash payments significantly declined from 2012. This study aims to explore the potential implications of increasing contactless payments on FB ingestion. METHODS UK Hospital Episode Statistics (HES) were reviewed between 2000 and 2022. All FB retrieval procedures involving the alimentary tract, respiratory tract and nasal cavity were included. Regression analysis was performed to assess trends in the incidence of FB ingestion before and following the transition to cashless payments in 2012. RESULTS Following the decline in cash payments in 2012, the frequency of alimentary tract FB removal procedures decreased significantly by 27.78 procedures per year (p < 0.001). Similarly, respiratory FB removal procedure decreased by 4.83 per year (p = 0.009) and nasal cavity FB removal procedures decreased by 52.82 per year (p < 0.001). CONCLUSIONS This study suggests a statistically significant decline in the number of procedures for removal of FB performed in the UK from 2012. Although this relationship is multifactorial, our data suggest an association between the introduction of contactless payments and a reduction in the number of FB retrieval procedures from the of upper aerodigestive tract.
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Affiliation(s)
- A Jangan
- Walsall Healthcare NHS Trust, UK
| | - E Watts
- University Hospitals Birmingham NHS Foundation Trust, UK
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Jo Y, Rim K, Kwon D, Ahn J, Paeng JY. Primary tooth aspiration during conscious sedation with N 2O: foreign body removal with rigid bronchoscopy. J Dent Anesth Pain Med 2024; 24:205-211. [PMID: 38840645 PMCID: PMC11148418 DOI: 10.17245/jdapm.2024.24.3.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/07/2024] Open
Abstract
A 7-year-old girl visited the Samsung Medical Center emergency room for primary tooth aspiration during primary tooth extraction under conscious sedation with N2O. The patient showed no signs of respiratory complications. Chest radiography and CT revealed a tooth in the right bronchi. Foreign body removal using rigid bronchoscopy was performed on the day of aspiration. With close monitoring of the airway in the pediatric ICU, extubation was performed the next day, and the patient was discharged the same day. The primary objective of this case report was to highlight the potential risk of aspiration associated with the use of N2O gas for conscious sedation.
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Affiliation(s)
- Yeeun Jo
- Department of Oral & Maxillofacial Surgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyungmin Rim
- Department of Oral & Maxillofacial Surgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Dohyun Kwon
- Department of Oral & Maxillofacial Surgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Jaemyung Ahn
- Department of Oral & Maxillofacial Surgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Jun-Young Paeng
- Department of Oral & Maxillofacial Surgery, Samsung Medical Center, Seoul, Republic of Korea
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Zhi-Pan T, Qi L, Xiao-Fei S. Three different surgical methods of the special tracheobronchial foreign body (pen cap) in children: Case series. SAGE Open Med Case Rep 2024; 12:2050313X241241216. [PMID: 38524381 PMCID: PMC10958796 DOI: 10.1177/2050313x241241216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
We present three novel cases of tracheobronchial foreign bodies (TFBs) in children caused by pen caps. One was removed by the rigid bronchoscopy successfully, the second was removed by rigid bronchoscopy combined with tracheotomy, and the last one was treated by bronchotomy from an external thoracic approach. Rigid bronchoscopy is the most widely used for treating TFBs in clinics, especially treating large and special foreign bodies, because rigid bronchoscopy can provide a good view for observation and operation. Successful removal of a foreign body under rigid bronchoscopy (an experienced doctor, suitable instruments, etc.) can obviate tracheotomy/tracheostomy or thoracotomy/bronchotomy.
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Affiliation(s)
- Teng Zhi-Pan
- Department of Otorhinolaryngology, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | | | - Shen Xiao-Fei
- Shen Xiao-Fei, Department of Otorhinolaryngology, Children’s Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, Jiangsu 210008, China.
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Sezer HF, Eliçora A, Topçu S. Foreign body aspirations with rigid bronchoscopy and esophagoscopy in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S55-S59. [PMID: 38584785 PMCID: PMC10995683 DOI: 10.5606/tgkdc.dergisi.2024.25688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/29/2023] [Indexed: 04/09/2024]
Abstract
Foreign body aspirations and esophageal foreign bodies are lifethreatening conditions. Sometimes they or their complications can cause severe morbidity and even mortality. Their exact incidence is unknown. Foreign body aspirations and esophageal foreign bodies are most commonly observed in the pediatric age group. While interventions are generally required for the removal of respiratory tract foreign bodies, the majority of esophageal foreign bodies come out spontaneously. Removal of foreign bodies that block the lumen of the organ to a great extent, react with the mucosa such as battery magnets, and can cause poisoning, sharp-edged objects, and swellable foreign bodies such as legumes, should be done acutely. In the removal of foreign bodies, endoscopic methods (flexible/rigid bronchoscope) are used in the respiratory system. Other methods used in esophageal foreign bodies are follow-up and pushing and pulling maneuvers with equipment, and at times, open surgical procedures can be applied. The success of the procedures is high, and patients can be discharged in the early postoperative period. Their incidence can be decreased by raising awareness on the subject, parents can be prevented from making wrong applications in these cases, and clinicians can keep these conditions in mind in differential diagnosis. In this article, the clinical features and diagnosis and treatment methods of foreign body aspiration and esophageal foreign bodies will be discussed separately.
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Affiliation(s)
- Hüseyin Fatih Sezer
- Department of Thoracic Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Aykut Eliçora
- Department of Thoracic Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Salih Topçu
- Department of Thoracic Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
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Takahashi H, Suzuki J, Ikeda R, Oishi T, Ohta J, Hirano-Kawamoto A, Katori Y. The Transition of Pediatric Tracheobronchial Foreign Body Cases in the Past 36 Years: A Retrospective Single-Center Study in Japan. TOHOKU J EXP MED 2023; 261:129-137. [PMID: 37532586 DOI: 10.1620/tjem.2023.j062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Tracheobronchial foreign bodies (TFBs) are pediatric airway emergencies frequently seen. We aimed to examine the changes in the clinical characteristics of pediatric TFB patients in a single institution within the past 36 years. We retrospectively reviewed the data of 85 patients aged 0-10 years with TFBs lodged in the trachea or bronchus admitted at the Department of Otolaryngology-Head and Neck Surgery at Tohoku University Hospital between 1986 and 2021. We also compared the characteristics, diagnostic methods, and treatments of the previous 64 cases (1986-2005) with those of the recent 21 cases (2006-2021). The number of TFB patients decreased later in this study (3.2 vs. 1.3 patients per year). The proportion of TFB patients aged > 3 years was significantly higher in the later period (6.3% vs. 23.8%, p = 0.038). Peanut was the most common cause of TFBs in both periods, and the overall incidence of peanut aspiration significantly decreased in the later period (68.8% vs. 38.1%, p = 0.019). No patient had an undetected TFB for more than 1 month after the onset of symptoms in the later period. Foreign body extraction using rigid bronchoscopy was performed in all patients earlier, whereas flexible bronchoscopy was used in 14.3% later. Our study revealed a recent trend in the clinical characteristics of pediatric TFB patients in a single institution in Northeast Japan. The prevention and treatment of pediatric TFBs should be considered following the recent trends.
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Affiliation(s)
- Hiyori Takahashi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
| | - Jun Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
| | - Ryoukichi Ikeda
- Department of Otolaryngology-Head and Neck Surgery, Iwate Medical University
| | - Tetsuya Oishi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
| | - Jun Ohta
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
| | - Ai Hirano-Kawamoto
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine
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Wu Y, Zhang X, Lin Z, Ding C, Wu Y, Chen Y, Wang D, Yi X, Chen F. Changes in the global burden of foreign body aspiration among under-5 children from 1990 to 2019. Front Pediatr 2023; 11:1235308. [PMID: 37727616 PMCID: PMC10506258 DOI: 10.3389/fped.2023.1235308] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
Background To evaluate the changes in the global burden of foreign body aspiration (FBA) among children under 5 years old at regional, age, sex, and socio-demographic index (SDI) levels between 1990 and 2019. Methods Data on FBA was derived from the Global Burden of Disease (GBD) Study 2019 database on pulmonary aspiration and foreign body in airway. The means and 95% uncertainty intervals (UIs) were calculated for incidence, and disability-adjusted life-years (DALYs). The temporal trends were represented by estimated annual percentage change (EAPC) using Joinpoint regression. Results Globally, FBA caused 109.6 (95% UI: 69.5, 175.7) per 100,000 incidence and 317.9 (95% UI: 270.7, 372.4) per 100,000 DALYs under 5 years old in 2019. Many European countries (such as Italy, Netherlands, Iceland, etc.) showed a high incidence rate, but did not cause a large disease burden (DALYs all less than 200 per 100,000). Compared to 1990, although a decrease in both incidence and DALYs occurred in 2019, the Joinpoint regression showed an increasing trend in incidence rate from 2014 to 2019 [APC: both (2.10), female (2.25), male (1.98), P < 0.05)], especially China, Netherlands, and Malta. Despite the lower incidence rate in early neonatal group and middle SDI areas, they instead resulted in higher DALYs than other age groups and areas. Conclusion Although declines occurred in incidence and DALYs of FBA among children under 5 years of age from 1990 to 2014, an upward trend began to emerge from 2014 to 2019. The incidence and DALY rates were correlated with age and SDI. Increased efforts are needed to improve the necessary monitoring and reporting systems, hazard assessment, and public education activities.
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Affiliation(s)
- Yuying Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xin Zhang
- Fujian Branch of Shanghai Children’s Medical Center, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Children’s Hospital, Fujian Medical University, Fuzhou, China
| | - Zaigang Lin
- Laboratory Animal Center, Fujian Medical University, Fuzhou, China
| | - Chenyu Ding
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yuxuan Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yue Chen
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Desheng Wang
- Department of Otolaryngology Head and Neck Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xuehan Yi
- Department of Otolaryngology Head and Neck Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fa Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
- Clinical Research Unit, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
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13
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Ekim A, Altun A. Foreign body aspirations in childhood: A retrospective review. J Pediatr Nurs 2023; 72:e174-e178. [PMID: 37355460 DOI: 10.1016/j.pedn.2023.06.025] [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: 02/05/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE The aim of this study was to examine the childhood-age foreign body aspiration (FBA) retrospectively by focusing on symptoms, types, home interventions, hospitalization and complications. METHOD All patients between 0-18 years admitted to pediatric surgical clinic and diagnosed with FBA were examined retrospectively from January 2021 to January 2022. RESULTS The study group consisted of 163 patients and their mean age was 17.8±12.7 months (1 months to 6 years). FBA events included aspiration of food (78%), coins (10%), batteries (3.7%), parts of toys (4%), buttons (2.4%) and other (2%). First aid treatment to children was performed at home by mothers (61%). Types of first aid treatment performed by mothers included tapping the back (31%); cleaning inside the mouth (24%); trying to remove the foreign body with fingers (12%), pushing the foreign body forward (5.9%) and forcing the child to vomit (9.5%) respectively. CONCLUSIONS FBA is a potential life-threatening health problem during childhood. When the age of majority of patients being under one year old and prevalence of food in FBA types are taken into consideration, safe-feeding practices of mothers, feeding position and training about the safe-environment are the basic steps of prevention strategies. PRACTICE IMPLICATIONS One of the most useful ways of preventing FBA cases is to provide planned and continuing education to parents, care givers and all the individuals responsible for the care of the child in order to increase their knowledge and practice levels.
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Affiliation(s)
- Ayfer Ekim
- Faculty of Health Sciences, Department of Pediatric Nursing, Istanbul Arel University, Istanbul, Turkey..
| | - Aslıhan Altun
- Graduate Education Institute, Istanbul Arel University, Istanbul, Turkey
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Goulioumis AK, Peridis S, Koudmnakis E, Athanasopoulos I. A Foreign Body Lodged in the Glottis of a Toddler for a Prolonged Time: Anatomical Considerations and Review of the Literature. Cureus 2023; 15:e44489. [PMID: 37791175 PMCID: PMC10544457 DOI: 10.7759/cureus.44489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Our scope is to present the unusual case of an impacted foreign body in a child's larynx for a prolonged period due to recurrent misdiagnosis and review the literature emphasizing the laryngeal foreign body. A toddler girl from a rural region was initially referred to a primary pediatric care center due to a sudden choking episode. The mother made an unsuccessful attempt to pull out a possible foreign body by blind finger sweeping. After 22 days of recurrent misdiagnosis and unsuccessful conservative therapies, the child developed hoarseness of voice and dyspnea during physical exertion. The patient underwent a flexible nasopharyngolaryngeal endoscopy, which observed a foreign body in the glottis, and an emergency microlaryngoscopy. Persistence of laryngeal symptoms in a child with a sudden choking episode should always raise the suspicion of a respiratory tract foreign body impaction. The most appropriate therapeutical approach is rigid bronchoscopy under general anesthesia.
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Affiliation(s)
| | | | | | - Ioannis Athanasopoulos
- Otolaryngology - Head and Neck Surgery, Pediatric Center of "Iatriko Athinon" Hospital, Athens, GRC
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Nutakor JA, Zhou L, Larnyo E, Gavu AK, Chohan IM, Addai-Dansoh S, Tripura D. The Relationship Between Social Capital and Sleep Duration Among Older Adults in Ghana: A Cross-Sectional Study. Int J Public Health 2023; 68:1605876. [PMID: 37457843 PMCID: PMC10338686 DOI: 10.3389/ijph.2023.1605876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Objective: This study aims to investigate the connection between social capital and sleep duration among older adults in Ghana, as limited research has been conducted to explore this relationship. Methods: This study utilized Wave 2 data from a sample of Ghanaian older adults from the World Health Organization Study on Global AGEing and Adult Health (SAGE). Self-reported data on social capital and sleep duration were compiled. Using ordered logistic regression, the relationship between social capital and sleep duration was examined. Results: Older adults who did not participate in social activities showed the strongest association with the risk of short sleep (p < 0.05). Our study found that older adults who sleep for shorter periods tend to report better sleep quality. There was no correlation between medium and long sleep durations and social capital. Conclusion: This study underscores the importance of more research to truly understand the complex connections between older adults' social participation, sleep, and health. It also has important implications for the promotion of good sleep in aging populations.
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Affiliation(s)
| | - Lulin Zhou
- School of Management, Jiangsu University, Zhenjiang, China
| | - Ebenezer Larnyo
- Center for Black Studies Research, University of California, Santa Barbara, CA, United States
| | - Alexander Kwame Gavu
- Department of Educational Administration, College of Education, University of Saskatchewan, Saskatoon, SK, Canada
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Mîndru DE, Păduraru G, Rusu CD, Țarcă E, Azoicăi AN, Roșu ST, Curpăn AȘ, Ciomaga Jitaru IM, Pădureț IA, Luca AC. Foreign Body Aspiration in Children-Retrospective Study and Management Novelties. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1113. [PMID: 37374317 DOI: 10.3390/medicina59061113] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Foreign body aspiration (FBA) is a frequent diagnosis in children. In the absence of other lung conditions, such as asthma or chronic pulmonary infections, this manifests as a sudden onset of cough, dyspnea, and wheezing. The differential diagnosis is based on a scoring system which takes into account the clinical picture as well as the radiologic aspects. The treatment that is considered the gold-standard for FBA in children remains to be rigid fibronchoscopy, however it comes with several potentially crucial local complications such as airway edema, bleeding, and bronchospasm, along inherent issues due to general anesthesia. Material and methods: Our study is a retrospective study analyzing the medical files of the cases from our hospital over the span of 9 years. The study group consisted of 242 patients aged 0-16 years diagnosed with foreign body aspiration in the Emergency Clinical Hospital for Children "Sfânta Maria" Iași, between January 2010-January 2018. Clinical and imaging data were extracted from the patients' observation sheets. Results: In our cohort, the distribution of children with foreign body aspiration was uneven, with the highest incidence being reported in children from rural areas (70% of cases), whereas the most affected age group was 1-3 years, amounting to 79% of all cases. The main symptoms which led to emergency admittance were coughing (33%) and dyspnea (22%). The most important factors that determined the unequal distribution were socio-economic status, which relates to a lack of adequate supervision by parents, as well as the consumption of food inappropriate for their age. Conclusions: Foreign body aspiration is a major medical emergency that may be associated with dramatic clinical manifestations. Several scoring algorithms designed to establish the need for bronchoscopy have been proposed, taking into account both the clinical and radiological results. The issue with asymptomatic or mild symptomatic cases, as well as difficulties managing cases with radiolucent foreign bodies, remains a challenge.
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Affiliation(s)
- Dana Elena Mîndru
- Department of Mother and Child Medicine, University of Medicine and Pharmacy "Gr.T.Popa", 700115 Iasi, Romania
- Clinical Hospital of Emergency for Children Sfanta Maria, 700309 Iasi, Romania
| | - Gabriela Păduraru
- Department of Mother and Child Medicine, University of Medicine and Pharmacy "Gr.T.Popa", 700115 Iasi, Romania
- Clinical Hospital of Emergency for Children Sfanta Maria, 700309 Iasi, Romania
| | - Carmen Daniela Rusu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy "Gr.T.Popa", 700115 Iasi, Romania
| | - Elena Țarcă
- Department of Mother and Child Medicine, University of Medicine and Pharmacy "Gr.T.Popa", 700115 Iasi, Romania
| | - Alice Nicoleta Azoicăi
- Department of Mother and Child Medicine, University of Medicine and Pharmacy "Gr.T.Popa", 700115 Iasi, Romania
| | - Solange Tamara Roșu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy "Gr.T.Popa", 700115 Iasi, Romania
| | | | - Irina Mihaela Ciomaga Jitaru
- Department of Mother and Child Medicine, University of Medicine and Pharmacy "Gr.T.Popa", 700115 Iasi, Romania
- Clinical Hospital of Emergency for Children Sfanta Maria, 700309 Iasi, Romania
| | | | - Alina Costina Luca
- Department of Mother and Child Medicine, University of Medicine and Pharmacy "Gr.T.Popa", 700115 Iasi, Romania
- Clinical Hospital of Emergency for Children Sfanta Maria, 700309 Iasi, Romania
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17
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Keil O, Schwerk N. Foreign body aspiration in children - being safe and flexible. Curr Opin Anaesthesiol 2023; 36:334-339. [PMID: 36745076 DOI: 10.1097/aco.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Anesthesia for foreign body removal in children can be quite challenging. Even though rigid bronchoscopy is considered the gold standard for foreign body removal, there is increasing evidence for successful foreign body removal using flexible bronchoscopy. This review discusses the recent implications for flexible bronchoscopy for the purpose of foreign body removal and will compare these findings to rigid bronchoscopy. RECENT FINDINGS During the last few years, several observational studies on foreign body removal by flexible bronchoscopy have been published, with promising results. SUMMARY Flexible bronchoscopy is a feasible and safe method for removing aspirated foreign bodies in children. In order to improve patient safety during the procedure, it is necessary for a pediatric anesthetist and a pediatric pulmonologist to work closely together. The anesthetist can take care of the administration of the anesthetic and maintenance of the vital functions, and the pulmonologist can carry out a safe and fast bronchoscopy. In the case of foreign body removal by flexible bronchoscopy, the anesthesiological procedure of choice should be general anesthesia with controlled ventilation via a laryngeal mask.
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Affiliation(s)
- Oliver Keil
- Clinic of Anesthesiology and Intensive Care Medicine
| | - Nicolaus Schwerk
- Clinic of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School
- BREATH (Biomedical Research in End-stage and obstructive Lung Disease Hannover), German Center for Lung Research (DZL), Hannover, Germany
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18
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Su S, Zhang H, Xiao L, Yao H, Ding L. Correlative Factors for Types of Tracheobronchial Foreign Bodies Encountered in Children. EAR, NOSE & THROAT JOURNAL 2023:1455613231167244. [PMID: 37010488 DOI: 10.1177/01455613231167244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE To characterize the correlative factors for types of tracheobronchial foreign bodies (TFBs) encountered in children. METHODS All included patients diagnosed with TFB underwent rigid bronchoscopy as the first surgery in the Children's Hospital of Chongqing Medical University. The data of 1026 patients aged 0-18 years were retrospectively collected between February 2019 and January 2022. RESULTS About 94.44% of the children with TFB had organic FBs, among which, peanuts were the most common FBs, followed by melon seeds and walnuts. The most common inorganic FBs included pen points or caps, plastic toys, and plastic papers. As compared to the children with organic FBs, those with inorganic FBs consisted of a higher proportion of children aged ≥3 years old, a time before surgery of >7 days, dyspnea, FBs size of >10 mm, longer operation time, more than two operation procedures, and atelectasis. On the other hand, the proportion of children with aspiration history, cough, and obstructive emphysema in the inorganic FB group was lower as compared to the organic FBs (P< .05). CONCLUSIONS The related factors related to the patient's characteristics, symptoms, operation situations, and preoperative complications can be predicted based on the identification of FB type.
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Affiliation(s)
- Shuping Su
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hengci Zhang
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling Xiao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbing Yao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling Ding
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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19
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Ding L, Su X, Yang D, Yao H, Xiao L. Risk factors for difficult removal of tracheobronchial foreign bodies in children by rigid bronchoscopy. Int J Pediatr Otorhinolaryngol 2023; 168:111539. [PMID: 37023557 DOI: 10.1016/j.ijporl.2023.111539] [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: 02/06/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To characterize the risk factors for difficult removal of tracheobronchial foreign body (FB) by rigid bronchoscopy in children. METHODS We retrospectively analyzed clinical data of 1026 pediatric patients (age: 0-18 years) diagnosed with tracheobronchial FB between September 2018 and August 2021. All patients underwent rigid bronchoscopy as the first intervention at our hospital. RESULTS Children aged 1-3 years accounted for 83.7% cases in our cohort. The most common symptoms were cough and wheeze. FBs were more frequently found in the right bronchus, and trachea FBs accounted for only 8.19% cases. The success rate of rigid bronchoscopy in a single attempt was 97.27%. 12.18% of the cases were defined as difficult removal of FB. On univariate analysis, age, CT findings (pneumonia), type of FB, diameter of FB, FB location, granulation tissue formation, and the seniority of the surgeon were identified as risk factors for difficult removal of tracheobronchial FBs. On multivariate analysis, age ≥3 years, FB diameter ≥10 mm, FBs located in left bronchus, multiple FBs, granulation tissue, and the seniority of surgeon (<3 years, ≥5 years) were independent risk factors for difficult removal. CONCLUSIONS Age, FB diameter, location of FB, granulation tissue formation, and the seniority of the surgeon were risk factors for difficult removal of FBs by rigid bronchoscopy.
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Affiliation(s)
- Ling Ding
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiujing Su
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Dazhi Yang
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbing Yao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling Xiao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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20
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Parvar SY, Sarasyabi MS, Moslehi MA, Priftis KN, Cutrera R, Chen M, Lili Z, Gonuguntla HK, Joseph T, Alajmi M, Alshammari S, Singh V, Parakh A, Indawati W, Triasih R, Fasseeh N. The characteristics of foreign bodies aspirated by children across different continents: A comparative review. Pediatr Pulmonol 2023; 58:408-424. [PMID: 36373422 DOI: 10.1002/ppul.26242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/05/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Foreign body aspiration (FBA) is a common issue in pediatric emergencies, with regional variations. Various cultures and foods, parents' and physicians' inadequate experience, and lack of bronchoscopy equipment are some attributable factors in the regional variation of FBA. AIM To more accurately represent the demographic characteristics of aspirated foreign bodies (FBs) across various continents, this review attempted to provide organized information based on the reviewed articles. METHODOLOGY A search was conducted in PubMed/PubMed Central, EMBASE, and google scholar. From the 36 included articles, information on age, gender, bronchoscopy type, type of FB, location, history of choking, and time elapsed between aspiration and admission were extracted. RESULTS A total of 14,469 cases were evaluated. According to the findings, children under two accounted for more than 75% of FBAs. Nuts and seeds were the most common FBs in most countries, whereas plastic and metal objects had higher rates in Brazil, and calcified objects were more prevalent in Thailand. The right bronchus was the most frequent location, and rigid bronchoscopy was the most often utilized type of bronchoscope. In addition, a significant percentage of patients were referred to the emergency rooms in the first 12-24 h following the aspiration incident. Moreover, Asian patients reported more choking history, and Europeans had fewer witnesses of FBA. CONCLUSIONS There is a lack of standardized reporting systems and organized guidelines in pediatric FBA. To select the ideal time for endoscopies and create educational programs, a collaboration between experienced researchers, pediatric pulmonologists, radiologists, and otolaryngologists is required.
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Affiliation(s)
| | | | - Mohammad Ashkan Moslehi
- Pediatric Interventional Pulmonology Division, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kostas N Priftis
- Children's Respiratory and Allergy Unit at National and Kapodistrian University of Athens, Zografou, Greece
| | - Renato Cutrera
- Pediatric Respiratory Department, Bambino Gesù Pediatric University Hospital, Rome, Italy
| | - Meng Chen
- Pediatric Interventional Respiratory Division, Qilu Children University Hospital, Shandong University, Jinan, China
| | - Zhong Lili
- Pediatric Respiratory Department, The Children's Medical Center of Hunan Provincial People's Hospital, Hunan University of Medical Sciences, Changsha, Hunan, China
| | - Hari K Gonuguntla
- Division of Interventional Pulmonology, Yashoda Hospitals, Hyderabad, India
| | - Tinku Joseph
- Interventional Pulmonology Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Mohsen Alajmi
- Pediatric Respirology and Interventional Pulmonology, Ahmadi Hospital, Al Ahmadi, Kuwait
| | - Salman Alshammari
- Department of Pediatrics, Pediatric Intensive Care Unit, Adan Hospital, Hadiya, Kuwait
| | - Varinder Singh
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Childrens Hospital, Delhi, India
| | - Ankit Parakh
- Pediatric Respiratory Division, BLK Max Hospital, New Delhi, India
| | - Wahyuni Indawati
- Child Health Department, Respirology Division, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rina Triasih
- Department of Pediatric, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada Dr. Sarjito Hospital, Yogyakarta, Indonesia
| | - Nader Fasseeh
- Respiratory and Allergy Unit, Faculty of Medicine, Alexandria Universty, Alexandria, Egypt
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21
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Cheng W, Li M, Yu S, Peng X, Zhang L, Zhou C, Wu Y, Zhang W. Epidemiological characteristics of community-acquired pneumonia and effects from the COVID-19 pandemic in Shenzhen of China. J Trop Pediatr 2022; 69:6917080. [PMID: 36525383 DOI: 10.1093/tropej/fmac111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to observe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the incidence of non-COVID-19 community-acquired pneumonia (CAP) in Shenzhen of China, offering new ideas for evaluating the effects of non-pharmaceutical interventions. METHODS A retrospective analysis was conducted of inpatients with pneumonia from 2017 to 2021. Epidemiological characteristics of CAP and effects from the COVID-19 pandemic were analyzed by the basic characteristics, time distribution, etiology and disease burden. RESULTS There were a total of 5746 CAP inpatient cases included from 2017 to 2021. The number of CAP hospitalizations decreased during the pandemic from 2020 to 2021, with seasonal variations of being higher in spring and winter and lower in summer and autumn, whereas it was prevalent throughout the year prior to the pandemic. The children group decreased significantly during the pandemic, with a 15% decrease in the share of CAP inpatients. The detection rates of bacteria and mycoplasma decreased in CAP patients, while the detection rate of the virus increased, and the number of moderate and severe cases reduced more than that of the mild. CONCLUSION Non-pharmaceutical interventions from COVID-19 have led to a decrease in the number of CAP inpatients, especially for children, with a specific seasonal prevalence in spring and winter, when the prevention interventions should be strengthened further for adults during the pandemic.
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Affiliation(s)
- Wenli Cheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Min Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Susu Yu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Xinyue Peng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Luyun Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Cheng Zhou
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
| | - Yanjie Wu
- Departments of Preventive Health Care and Hospital Infection Management, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China
| | - Wenjuan Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, China
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22
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Gayen GC, Das D, Ray R, Maitra M. Management of Tracheo-Bronchial Foreign Bodies in Children: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:536-539. [PMID: 36514432 PMCID: PMC9741687 DOI: 10.1007/s12070-022-03098-x] [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: 09/24/2021] [Accepted: 01/01/2022] [Indexed: 12/15/2022] Open
Abstract
(1) To study the epidemiological profile of the patients. (2) To study the various modalities of investigations to arrive at confirmatory diagnosis. (3) To study the post-operative complications. It was a hospital based prospective study. A total of 36 paediatric patients were included in the study over a duration of 2 years (August 2017 to July 2019). Written informed consent was taken from the parent of each patient before performing bronchoscopy. All the patients were subjected to careful clinical examination and investigations required followed by emergency bronchoscopic removal of foreign body. The patients were followed up at 1 and 3 months after bronchoscopic removal. Amongst the 36 cases, 12 cases presented with airway emergency which addressed by bronchoscopic removal immediately. 10 cases presented with suggestive history of foreign body aspiration were subjected to clinical and radiological studies followed by bronchoscopic removal. 14 cases were referred from paediatric in-patient department who were being treated for unresolved LRTI. Early intervention is life saving if timely done. Unresolved LRTIs should be looked carefully to address missed foreign bodies. HRCT Thorax with 3-D reconstruction (Virtual Bronchoscopy) helps in exact localization of the foreign body. Experienced team of surgeons and anesthetist along with a ICU support is needed for efficient management.
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Affiliation(s)
- Ganesh Chandra Gayen
- Department of ENT and Head Neck Surgery, Malda Medical College and Hospital, Singatala, Uma Roy Sarani, Malda Town, West Bengal 732101 India
| | - Debabrata Das
- Department of ENT and Head Neck Surgery, R G Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata, West Bengal 700004 India
| | - Ritam Ray
- Department of ENT and Head Neck Surgery, Burdwan Medical College and Hospital, Frazer Avenue, Burdwan, 713104 India
| | - Mainak Maitra
- Department of ENT and Head Neck Surgery, Malda Medical College and Hospital, Singatala, Uma Roy Sarani, Malda Town, West Bengal 732101 India
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23
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Han LL, Meng C, Zhang ZX, Tang XD, Ma J, Li CX. Clinical analysis of bronchoscope diagnosis and treatment for airway foreign body removal in pediatric patients. Ital J Pediatr 2022; 48:159. [PMID: 36056440 PMCID: PMC9438306 DOI: 10.1186/s13052-022-01347-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Along with the wide spread application and technical development of the flexible and rigid bronchoscopy, the airway foreign body removing method cme to the specific technique for different foreign bodies from the single foreign body forceps. Methods Selected 633 children who were diagnosed as airway foreign bodies by the Department of Respiratory Intervention, Children's Hospital affiliated to Shandong University from January 1st, 2018 to December 31st, 2021, and the airway foreign bodies were diagnosed using bronchoscopy. After comprehensive assessment of the foreign body nature in the airway, the foreign bodies were removed by freezing, laser, electrocoagulation, balloon and other techniques, the success rate of the foreign body removed from the airway was observed, the percentage of the foreign body removed using different techniques, the operation time, and the incidence of post-adverse reactions during operation. Results The success rate using flexible bronchoscope alone to remove foreign bodies in the airway was 99.2%. After flexible bronchoscopy, 19 cases of foreign bodies were removed by vacuum suction alone, 513 cases were removed by foreign body forceps alone, 62 cases were combined with cryotherapy, 2 cases were electrocoagulation, 6 cases were mesh baskets, 3 cases were balloons, 5 cases were laser, and various 18 cases of foreign bodies were invloved by technical combination. 5 cases of flexible bronchoscope combined with rigid bronchoscope combined to remove foreign bodies. The operation time was from 5 min to 1 h, with an average of 20 min. There were 17 cases of hypoxemia (2.7%) during operation, 36 cases (5.7%) of bleeding caused by airway mucosa injury after treatment, and 70 cases (11.2%) of laryngeal edema. The total incidence of adverse reactions was 19.6%, there were no deaths due to foreign bodies and treatment. Conclusions According to different properties of airway foreign bodies, it is safe and effective to select appropriate techniques to remove foreign bodies using the flexible bronchoscope, which can increase the removal rate of airway foreign bodies and reduce the occurrence of serious complications.
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Affiliation(s)
- Lin-Lin Han
- Center for Respiratory Intervention, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Chen Meng
- Center for Respiratory Intervention, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Zhong-Xiao Zhang
- Center for Respiratory Intervention, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Xiao-Di Tang
- Center for Respiratory Intervention, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Jing Ma
- Center for Respiratory Intervention, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Chang-Xiao Li
- Center for Respiratory Intervention, Children's Hospital Affiliated to Shandong University, Jinan, China.
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24
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Chantzaras A, Panagiotou P, Karageorgos S, Douros K. A systematic review of using flexible bronchoscopy to remove foreign bodies from paediatric patients. Acta Paediatr 2022; 111:1301-1312. [PMID: 35388522 DOI: 10.1111/apa.16351] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 12/23/2022]
Abstract
AIM Our aim was to summarise the evidence about flexible bronchoscopy for paediatric airway foreign body aspiration cases. METHODS We searched the PubMed database from 1 January 2001 to 9 October 2021 for peer-review papers published in English on the use, and success rates, of flexible bronchoscopy as the first-line treatment for foreign body aspiration cases. This process identified 243 potential papers. RESULTS We studied 23 papers comprising 2588 cases of foreign body aspiration and flexible bronchoscopy successfully removed the foreign bodies in 87.1% of cases. Complication rates were low in the 983 patients studied in 18 papers. The foreign bodies were organic materials in 78.3% of 1371 patients and mainly lodged in the right bronchial tree in 50.5% of 1402 patients. General anaesthesia was used before flexible bronchoscopy in 14/23 studies and laryngeal mask airways were mostly used in 10/23 studies to secure the airway during the procedure. Ancillary equipment was used to assist the foreign body removal in 57.3% of 1808 cases and these were usually baskets. CONCLUSION Flexible bronchoscopy was a feasible and safe therapeutic procedure for selected foreign body aspiration cases. Future studies need to focus on comparing the clinical outcomes of flexible and rigid bronchoscopies.
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Affiliation(s)
| | - Panagiota Panagiotou
- First Department of Pediatrics Aghia Sophia Children’s Hospital National and Kapodistrian University of Athens Athens Greece
- Evelina London Children’s Hospital London UK
| | - Spyridon Karageorgos
- First Department of Pediatrics Aghia Sophia Children’s Hospital National and Kapodistrian University of Athens Athens Greece
| | - Konstantinos Douros
- Pediatric Allergy and Respiratory Unit 3rd Department of Paediatrics School of Medicine Attikon University Hospital National and Kapodistrian University of Athens Athens Greece
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25
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Goussard P, Merven M, Parker N, Gie A, Myburgh C, Andronikou S, Wagenaar R. Foreign body aspiration in two young infants: The devil in the carpet. Pediatr Pulmonol 2022; 57:1795-1798. [PMID: 35546251 DOI: 10.1002/ppul.25965] [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: 04/21/2022] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022]
Abstract
Foreign body aspiration is rare in children below 6 months of age. Very young children presenting with stridor, atypical croup presentation, and not responding accordingly, subglottic foreign body aspiration should be considered. These may not always be visible with bedside flexible endoscopy and may need investigation under anesthesia. We report two cases of devil's thorn aspiration in young infants. These children were left on the floor to play and devils thorn may be a danger lurking as the they have been deposited unknowingly by the shoes people wear and pick up by these young infants.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Marc Merven
- Department of Otorhinolaryngology, Tygerberg Hospital, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Noor Parker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Andre Gie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Chantelle Myburgh
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Radiology, Perelman School, of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Riegart Wagenaar
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa
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26
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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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27
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Successful Management Foreign Body Aspiration Associated with Severe Respiratory Distress and Subcutaneous Emphysema: Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58030396. [PMID: 35334572 PMCID: PMC8955108 DOI: 10.3390/medicina58030396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Abstract
The presence of a foreign body in the airway is a potentially life-threatening clinical condition that requires urgent medical attention. We present a case of a 12-year-old boy who presented in the emergency room with a history of an episode of choking after aspiration of a foreign body, followed by severe respiratory distress and subcutaneous emphysema. Chest radiography revealed hyperinflation data, pneumothorax, and subcutaneous emphysema data. The flexible bronchoscope examination showed the presence of an inorganic foreign body impacted on the carina with tracheal lesions and laryngeal edema. It was necessary to perform a tracheostomy for its definitive extraction. The gold standard in the treatment of foreign body aspiration is bronchoscopy; although, in children, the technique adopted continues to be controversial, flexible bronchoscopy can be effective and very useful.
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28
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Ding L, Su S, Chen C, Yao H, Xiao L. Tracheobronchial Foreign Bodies in Children: Experience From 1,328 Patients in China. Front Pediatr 2022; 10:873182. [PMID: 35722476 PMCID: PMC9199421 DOI: 10.3389/fped.2022.873182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the clinical characteristics of tracheobronchial foreign body (FB) cases in a pediatric Chinese population. METHODS The clinical data of pediatric patients aged 0-18 years old diagnosed with a tracheobronchial FB in the Children's Hospital of Chongqing Medical University between September 2018 and August 2021 were analyzed retrospectively. RESULTS Among 1,328 included cases, 92.09% of patients were <3 years old, the male to female ratio was 1.86:1. The prevalence of tracheobronchial FB was similar between patients living in rural and urban areas and tracheobronchial FBs were more common in winter. The most common presenting symptoms were cough and wheezing. The most common CT findings was local obstruction or tracheobronchial narrowing, followed by obstructive emphysema of lung and pneumonia. The 11.3% of cases that did not report FB aspiration on admission had a longer time to hospital admission and longer hospitalization time than cases reporting FB aspiration (P < 0.05). The most common FB type was nuts (81.17%). FBs were more frequently located in the right bronchus, and 64 (4.82%) cases involved multiple FBs. FBs were expelled by coughing in only 4.07% of cases. For the other cases, FB removal by first bronchoscopy in our hospital was successful and complete in 96.86% of cases. 1.51% of patients had hypoxic ischemic encephalopathy (HIE) and the location of FBs was a possible risk factor for HIE (P < 0.05). CONCLUSIONS Tracheobronchial FBs occurred most commonly in children <3 years old. If asphyxia occurs in children which FBs aspirated, emergency treatment is needed to reduce the occurrence of HIE. Rigid bronchoscopy remains the first-line method for FB removal in children.
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Affiliation(s)
- Ling Ding
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
| | - Shuping Su
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
| | - Cheng Chen
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
| | - Hongbing Yao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
| | - Ling Xiao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
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29
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Zhu Y, Fan Q, Cheng L, Chen B. Diagnostic Errors in Initial Misdiagnosis of Foreign Body Aspiration in Children: A Retrospective Observational Study in a Tertiary Care Hospital in China. Front Pediatr 2021; 9:694211. [PMID: 34722414 PMCID: PMC8555661 DOI: 10.3389/fped.2021.694211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Foreign body aspiration (FBA) in children is a common emergency that can easily be missed, leading to delays in treatment. Few large cohort studies have focused on errors in diagnostic assessment. The main purpose of this study was to analyze factors contributing to the initial misdiagnosis of FBA in children. Methods: We retrospectively reviewed the charts of 226 children diagnosed with FBA at the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2018 to November 2020. Cases were divided into two groups according to whether or not patients were initially misdiagnosed. The clinical characteristics of the two groups were then compared. The Diagnosis Error Evaluation and Research (DEER) taxonomy tool was applied to cases with initial misdiagnosis. Results: Of the 226 included children with a final diagnosis of FBA, 153 (67.7%) were boys. Ninety percent of patients were under 3 years old. More than half (61.9%) of the children were referred from primary institutions, and 38.1% visited tertiary hospitals directly. A total of 80 (35.4%) patients were initially misdiagnosed. More than half of misdiagnosed children received an alternative diagnosis of bronchiolitis (51.3%), the most common alternative diagnosis. Test failures (i.e., errors in test ordering, test performance, and clinician processing) were primarily responsible for the majority of initial diagnostic errors (76.3%), followed by failure or delay in eliciting critical case history information (20.0%). Characteristics significantly associated with initial misdiagnosis were: presentation over 24 h (OR 9.2, 95% CI 4.8-17.5), being referred from primary institutions (OR 8.8, 4.1-19.0), no witnessed aspiration crisis (OR 7.8, 3.0-20.3), (4) atypical signs or symptoms (OR 3.2, 1.8-5.7), foreign body not visible on CT (OR 36.2, 2.1-636.8), foreign body located in secondary bronchi (OR 4.8, 1.3-17.2), organic foreign body (OR 6.2, 1.4-27.2), and history of recurrent respiratory infections (OR 2.7, 1.4-5.3). Children with misdiagnosis tended to have a longer time from symptom onset to the definitive diagnosis of FBA (P < 0.001). Conclusions: More than one-third of children with FBA were missed at first presentation. Errors in diagnostic testing and history taking were the main reasons leading to initial misdiagnosis.
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Affiliation(s)
- Yingchao Zhu
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Qijun Fan
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Lijun Cheng
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Bobei Chen
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
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30
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Mathew RP, Liang TIH, Kabeer A, Patel V, Low G. Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the paediatric population: Part 2. SA J Radiol 2021; 25:2027. [PMID: 33936796 PMCID: PMC8063769 DOI: 10.4102/sajr.v25i1.2027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023] Open
Abstract
Children, especially toddlers, because of their behaviour, physiology and anatomical characteristics such as oral exploration of their surroundings, have a tendency to place objects in their mouth. Therefore, ingestion or aspiration of foreign bodies (FBs) in children is a potentially life-threatening and common problem seen across the world. In this second part of our pictorial review on ingested and aspirated FBs, we focus on the paediatric population, reviewing the current literature and examining the epidemiology, clinical presentation, anatomic considerations, appropriate imaging modalities, key imaging characteristics associated with clinically relevant FBs in the emergency department (ED) and current management protocols.
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Affiliation(s)
- Rishi P Mathew
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | - Teresa I-Han Liang
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| | - Ahamed Kabeer
- Department of Pediatric Surgery, Rajagiri Hospital, Aluva, India
| | - Vimal Patel
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
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