Extraction of a Large Central Airway Foreign Body Using Flexible Bronchoscopy Combined with an Endobronchial Blocker

Failures in emergency management of pediatric airway foreign bodies by rigid bronchoscopy: we have yet to complete our learning

Background

Several children are affected by airway foreign body aspiration (FBA) resulting from life-threatening conditions. Choking has been considered the major symptom and is defined as airway blockage by a foreign body (FB), leading to marked morbidity or mortality. This retrospective study indicates the possibility of misdiagnosis or rigid bronchoscope (RB) failure, which is the standard gold method for extracting FB in the airway.

Methods

Six children with airway FBA who failed treatment using RB between 2018 and 2019 were retrospectively studied. The inclusion criterion was a history of failure to extract FB using RB followed by flexible fiberoptic bronchoscopy (FFB).

Results

In the present study, among 63 patients who had undergone rigid bronchoscopy, airway FBs were successfully removed in 57 (90.48%). Rigid bronchoscopy failed in 6 (9.52%) patients. The age of cases at the time of bronchoscopy ranged from 11 months to 13 years. FFB was performed to extract missing or remaining FBs and was done successfully in all patients. The patients made an uneventful recovery following FB extraction using the FFB method.

Conclusions

It is not easy to diagnose and treat airway FB in children. Rigid bronchoscopy has been approved as a method to manage airway FB, but a negative bronchoscopy result must usually be interpreted carefully. FFB is applicable as a proper and relatively safe diagnostic and therapeutic tool in managing airway FBs among the pediatric population, especially in cases where rigid bronchoscopy was performed but missed or failed to extract the FB.

Undiagnosed chicken meat aspiration as a cause of difficult-to-ventilate in a boy with traumatic brain injury

Introduction

Bronchoscopy is a commonly used procedure in the context of aspiration in the Intensive Care Unit setting. Despite its ability to remove mucus plug and undigested gastric contents, aspiration of gastric content into the trachea is one of the most feared complications among anesthesiologist.

Discussion

The scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes.

Case presentation

We present a case of a 12-year-old boy who had a difficult-to-ventilate scenario post transferring and immediately connected to ventilator in operation theatre (OT) from portable ventilator from the emergency department. She was successfully managed by bronchoscopy.

Conclusion

Special attention should be given to the difficult-to-ventilate scenario post intubation of traumatic brain injury patient prior to operation. Prompt diagnosis and bronchoscope-assisted removal of foreign body was found to be a successful to reduce morbidity and mortality.