Flexible bronchoscopy for foreign body aspiration in children:A single-centre experience

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.

Aspiration of foreign bodies that allow air passage through

Foreign body aspiration is commonly encountered in children. In cases that foreign body does not disturb respiratory physiology, clinical and radiological diagnosis may be delayed leading to severe complications. Four cases with aspiration of a foreign body not obstructing ventilation and without typical clinical and radiological findings are discussed.

Migrating Foreign Body Bronchus: An Unusual Case of Foreign Body Aspiration

Foreign bodies [FB] in the bronchus are important causes of morbidity and mortality in paediatric age group and pose diagnostic and therapeutic challenges. Inert and smooth foreign bodies are prone for migration from one side to other due to minimal inflammatory process and easy mobility. Herein we are reporting a case of electric bulb aspiration which migrated from right main bronchus to left main bronchus.

The use of fiberoptic bronchoscope to remove aspirated tracheobronchial foreign bodies: Our experience

Background: Foreign body (FB) aspiration is a common emergency in our practice. The routine method of removal is via rigid bronchoscopy (RB) under general anesthesia. This is the preferred procedure particularly in children who form the major affected population. Fiberoptic bronchoscopy (FOB) has also been used for FB removal in many countries, though in Iraq, the standard mean remains rigid bronchoscopy. Objective: Herein, we present 5 cases of FB inhalation in adults in whom FOB was used for removal. The aim is to test its feasibility with literature review. Setting: the department of thoracic surgery/Sulaimania Teaching Hospital/Sulaimania/Iraq. Study Design: a prospective study of 5 patients. Patients and methods: 5 patients (3 females and 2 males) with different bronchial or laryngeal FBs in whom FOB was used as a method for removal are presented. The age ranged from 16 to 71 years. The clinical and radiographic features are recorded. In all these patients, initial FOB examination under local anesthesia transorally or via tracheotomy stoma was done. When removed by this method failed, RB under GA was used and when this failed, thoracotomy was the last resort. Results and Conclusions: FBs encountered in this paper consisted of pins (n = 2), sewing needle (n = 1), speech valve (n = 1) and a medical leach (n = 1). Three FBs (medical leach, speech valve and one pin) were successfully removed by FOB. A pin in RMB was visualized but failed to be removed by FOB and therefore, RB was required for its retrieval, while a needle in left lower lobe was invisible by both FOB and RB and thus surgery was necessary to remove it. We conclude that in adolescent or adult patients with bronchial FBs, FOB should be tried first for removal. If this fails then RB can be used. To increase its success, FOB should be combined with certain accessories like special FB forceps and fluoroscopy.

Airway foreign bodies: A critical review for a common pediatric emergency

BACKGROUND:Airway foreign bodies(AFBs)is an interdisciplinary area between emergency medicine,pediatrics and otolaryngology.It is a life-threatening condition that is not infrequently seen;however,it is poorly covered in medical literature.Accidental aspiration of an element into airways is a widespread clinical scenario among children under 3 years,predominantly males.Moreover,it is the leading cause of infantile deaths and the fourth one among preschool children.DATA RESOURCES:A systemic search was conducted in July 2015 using Pub Med/Pub Med Central Database of The National Center for Biotechnology Information(NCBI)(http://www.ncbi.nlm.nih.gov/).A total of 1 767 articles were identified and most of them were meta-analyses,systematic reviews,and case series.Those thoroughly discussing assessment and management of AFBs were retrieved.RESULTS:AFBs episodes may be either witnessed or missed.Presence of a witness for the inhalation is diagnostic.The later usually present with persistent active cough.A classical triad of paroxysmal cough,wheezing,and dyspnoea/decreased air entry was reported,though many presentations have inconsistent findings.Hence,diagnosis requires high index of clinical suspicion.Flexible fibro-optic bronchoscopy is the gold standard of diagnosis,whereas inhaled objects are best retrieved by rigid bronchoscopes.CONCLUSIONS:Close supervision of pediatrics is the hallmark of prevention.Caregivers should ensure a safe surrounding milieu,including the toys their offspring play with.Immediate complications result from direct obstruction or injury by the inhaled object.Alternatively,prolonged lodging traps air and induces inflammatory response causing atelectesis and pneumonia,respectively.

Endoscopic management of ingested foreign bodies in children: A retrospective review of cases, and review of the literature

Background: Foreign body (FB) ingestion by children is a common problem worldwide. Management may include endoscopic removal. This paper describes the clinical findings, sites and types of FBs, and outcomes in children who underwent endoscopic management of ingested FBs at our institution. The published literature regarding the management of FB ingestion in children is also reviewed. Methods: We retrospectively reviewed the records of all patients aged <14 years who underwent endoscopic management of gastrointestinal FBs between July 2002 and June 2012 (47 patients) and tracheobronchial FBs between December 2010 and June 2012 (17 patients) at our institution. Patient characteristics, clinical findings, sites and types of FBs, and outcomes were recorded. Results: The 47 patients with gastrointestinal FBs included 29 males and 18 females with a mean age of 3.5 years. The most common symptoms were difficulty with swallowing and vomiting in 16 patients (34%), chest pain in 10 (21%), and coughing and breathing difficulty in 7 (15%). The most common FB site was the esophagus (36 patients). Most gastrointestinal FBs were metallic, with coins being the most common. Endoscopic removal was successful in 43 patients. The 17 patients with tracheobronchial foreign bodies included 9 males and 8 females with a mean age of 3.2 years. The most common symptoms were breathing difficulty in 12 patients (71%) and coughing in 3 (18%). The most common tracheobronchial FBs were nuts (10 patients). Bronchoscopic removal was successful in all 17 patients. Conclusions: Coins were the most common gastrointestinal FBs, and nuts were the most common tracheobronchial FBs. Clinical presentations were variable, and a high index of suspicion is necessary. Endoscopic removal is safe and effective, and early diagnosis and management result in favorable outcomes.

Five Centimeter Concrete Nail Aspiration in a 2-Year-Old Nigerian Child: A Call for More Parental/Care-Givers’ Education: A Case Report

Introduction: Foreign body (FB) aspiration is a common cause of respiratory emergency in early childhood. Parents and care-givers are usually unaware of initial time of FB aspiration, and the varied symptoms may be confusing to them. Therefore, education on ways of avoiding the inci-dence is paramount, and prompt hospital presentation will reduce morbidity and mortality. Case Report: A 5 cm concrete nail, which was aspirated by a 2-year-old male Nigerian child of the Hausa ethnic group, was successfully removed by rigid bronchoscopy. We emphasize the need for more parental/care-givers’ education on foreign body aspiration among children. Conclusion: Infants commonly play with objects by inserting them in various orifices of their body. This, therefore, predisposes them to aspiration, which will go unnoticed at the time of aspiration. There is a need for repeated parental/care-givers’ education on dangers of allowing children to play alone. Parents/care-givers should be conversant with varied presentations of FB aspiration in children, as this will reduce the morbidity and mortality to the minimum.

Advantage of Computed Tomography (CT) Virtual Bronchoscopy in the Evaluation of Children with Suspected Foreign Body Airway

Background & Objectives: Foreign body aspiration (FBA) into the tracheo bronchial tree is a frequent and serious cause of respiratory distress and visit to the pediatrics emergency, principally in patients under 3 years of age. Most foreign bodies are not radio opaque and approximately one third of the children admitted will show normal chest X-ray. Virtual bronchoscopy is a relatively new and non-invasive procedure that provides a three dimensional view of the internal walls of the tracheobronchial tree through the reconstruction of axial images. The objectives of the study are, 1) to study the diagnostic accuracy and advantage of virtual bronchoscopy over rigid bronchoscopy in the evaluation of children with suspected FBA and to plan for early management as it is a non-invasive technique;2) to study the clinical spectrum of children attending with suspected FBA. Methods: An observational study of 37 patients of age 12 yrs and below who underwent Virtual Bronchoscopy for suspected foreign body aspiration in the department of pediatrics and Otorhinolaryngology at MGM Hospital, Warangal is carried out for a period of 1.5 years during 2012-2013. Results: The common age of presentation was 1 - 3 years with male preponderance. History of foreign body was obtained in 64.86% of cases. Normal X-ray was found in 27.02% of cases. In 75.67% FB detected on rigid bronchoscopy was also revealed on virtual bronchoscopy. False positive percentage was 5.40% and false negative was 2.70%. Sensitivity and specificity was 96.5% and 75% respectively. Ground nuts were the commonest foreign bodies aspirated. Conclusion: Virtual bronchoscopy should be considered in cases with suspected foreign body aspiration, when chest X-ray is normal, to avoid needless rigid bronchoscopy. Virtual bronchoscopy is useful in screening cases of occult foreign body as it has sensitivity, specificity, and validity.

Pneumomediastinum Secondary to Foreign Body Aspiration： Clinical Features and Treatment Explorement in 39 Pediatric Patients

Background：Pneumomediastinum （PM） secondary to foreign body aspiration （FBA） is rare in children.Although it is mainly benign,some cases may be fatal.Due to the rare nature of this clinical entity,proper assessment and management have been poorly studied so far.Here,we characterized the presentation and management of this clinical entity and provided an evaluation system for the management.Methods：We retrospectively reviewed children with PM secondary to FBA,who were treated in Beijing Children＇s Hospital from January 2010 to December 2015.All patients were stratified according to the degree of dyspnea on admission,and interventions were given accordingly.Bronchoscopic removals of airway foreign bodies （FBs） were performed on all patients.For patients in acute respiratory distress,emergent air evacuation and/or resuscitations were performed first.Admission data,interventions,and clinical outcomes were recorded.Results：A total of 39 patients were included in this study.The clinical severity was divided into three grades （Grades Ⅰ,Ⅱ,and Ⅲ） according to the degree of dyspnea.Thirty-one patients were in Grade Ⅰ dyspnea,and they simply underwent bronchoscopic FBs removals.PM resolved spontaneously and all patients recovered uneventfully.Six patients were in Grade Ⅱ dyspnea,and emergent drainage preceded rigid bronchoscopy.They all recovered uneventfully under close observation.Two exhausted patients were in Grade Ⅲ dyspnea.They died from large PM and bilateral pneumothorax,respectively,despite of aggressive interventions in our hospital.Conclusions：PM secondary to FBA could be life-threatening in some patients.The degree of dyspnea should be evaluated immediately,and patients in different dyspnea should be treated accordingly.For patients in Grade Ⅰ dyspnea,simple bronchoscopic FBs removals could promise a good outcome.For patients in Grade Ⅱ dyspnea,emergent air evacuation and/or resuscitation should precede a bronchoscopy before the children become exhausted.

儿童呼吸道异物早晚期诊断与异物类型、部位及并发症的关系研究

目的探讨儿童呼吸道异物早晚期诊断与异物类型、部位及术前并发症的关系。方法回顾性分析本院收治的2 773例儿童呼吸道异物病例资料,按24 h内确诊和24 h之后确诊分为早期诊断组和晚期诊断组,比较异物类型、部位、并发症类型在两组间的统计学差异。结果本研究共2 773例呼吸道异物患儿,男女比例为1.89∶1,异物类型以植物类异物2 561(92.35%)例为主,异物部位以支气管异物2 257(81.39%)为主,术前最常见的并发症为肺炎(43.30%)和肺气肿术(27.60%)。研究发现金属类异物早期诊断率明显高于植物性异物,不同异物类型早期诊断率存在差异(χ~2=47.125,P<0.05))。早晚期诊断组患儿中术前肺炎、肺气肿的发生率存在差异,经统计学分析差异有统计学意义(P<0.001)。19例并发气胸者异物均为坚果类。除1例内源性异物患儿术后死亡外,其余病例均获治愈。术后新发并发症如肺水肿、气胸9例,二次手术4例,以上患儿异物均为坚果。17例气管、双侧支气管异物患儿因ARD转入ICU治疗,其中15例异物为坚果。结论异物类型是影响呼吸道异物能否早期确诊的相关因素,大多数坚果类异物由于发生场景无特殊、异物性状及滞留位置,早期难以确诊,病程越长,并发症发生率越高。对于气管、双侧支气管异物合并肺炎、气胸的患儿,坚果类异物也增加了发生ARD的风险性。

气管和支气管异物住院儿童的流行特征及其预防

目的:了解因气管和支气管异物住院治疗儿童的流行特征,探讨儿童气管和支气管异物的预防措施。方法:描述性统计分析某省儿童医院5年间收治的0-13岁因气管、支气管异物住院儿童。结果:5年间儿童气管、支气管异物住院病例总数逐渐递增;91.99％的气管、支气管异物发生在3岁以下儿童;男女性别比为1.84:1;异物吸入主要发生在家中;吸入异物种类以食物性异物为主(94.87％),其中又以植物性食物,如花生仁、瓜子类和豆类为多(88.14％);进食时嬉笑、哭闹是异物吸入的主要原因(64.47％)。结论:气管、支气管异物住院儿童在性别、年龄、异物吸人情况等方面分布特征明显。加强对儿童及其父母和看护人意外伤害的健康教育,有助于降低本病发病率。

小儿支气管异物取出术的麻醉处理

目的探讨小儿支气管异物取出术的麻醉处理方案。方法回顾性分析112例小儿支气管异物取出术的麻醉处理。Ⅰ组,静脉注射丙泊酚,首剂量2mg/kg,维持剂量4～8mg·kg-1.h-1,辅以氯胺酮2mg/kg;Ⅱ组,静吸复合麻醉,静脉注射氯胺酮2mg/kg后,经面罩吸入七氟烷3%～4%;Ⅲ组,静脉注射γ-羟基丁酸钠50mg/kg、氯胺酮2mg/kg,术中追加氯胺酮每次1mg/kg;所有患儿入睡后均以1%地卡因在咽喉部作喷雾表面麻醉;分别记录各组术中屏气呛咳、脉搏血氧饱和度(SpO2)降至90%以下、硬质支气管镜退出气道、气管插管以及喉水肿或喉痉挛等的发生率和苏醒时间。结果Ⅲ组屏气呛咳、支气管镜退管以及喉痉挛或喉水肿的发生率均显著低于Ⅰ、Ⅱ组(P值均<0.05),苏醒时间显著长于Ⅰ、Ⅱ组(P值均<0.05)。结论小儿支气管异物取出术的麻醉选择以静脉注射γ-羟基丁酸钠、氯胺酮和1%地卡因局部表面麻醉为佳。

一种新型面罩联合Storz硬质支气管镜在小儿气管支气管异物取出术中的应用

目的评价使用一种新型面罩联合Storz硬质支气管镜在小儿支气管异物取出术中的有效性和安全性。方法选择行气管及支气管异物取出术的患者60例随机分成两组:实验组30例和对照组30例,(实验组,新型面罩联合Storz硬质支气管镜;对照组,Storz硬质支气管镜)。两组均实施小剂量短效肌松剂的全身麻醉,观察患者术中SPO2变化情况及控制呼吸给氧次数,并记录麻醉前(T0)、支气管镜进入气管前(T1)、支气管镜进入气管后1 min(T2)、支气管镜进入气管后3 min(T3)、支气管镜进入气管后5 min(T4)及术毕退出支气管镜后(T5)患者的血压、心率和手术所用时间及并发症。结果组间各时点患者的血压及心率变化不大(P>0.05),组内各时点患者的血压及心率比较有统计学差异(P<0.05);术中暂停手术行控制呼吸给氧次数及手术时间,实验组与对照组比较有统计学差异(P<0.05)。结论该新型面罩联合Storz硬质支气管镜控制呼吸用于小儿支气管异物取出术,不仅能维持良好的血氧饱和度,保证麻醉的安全性,而且还为手术提供良好的操作条件,值得临床推广。

纤维支气管镜对支气管异物漏诊患者的诊治价值

为探讨支气管异物的漏诊原因和总结纤维支气管镜（ Ｆ Ｂ）对该病的诊治经验，作者对曾被误诊为其它疾病并经 Ｆ Ｂ检查确诊的１２例支气管异物患者的诊治经验进行了总结分析。结果发现，该１２例患者均因无明确的异物吸入史，胸片上未能见及异物，仅见及肺不张，肺门阴影增大及阻塞性肺炎，以及临床表现为支气管肺感染或喘息等，而被误诊为肺癌、肺炎、哮喘和肺结核。经 Ｆ Ｂ检查后均获确诊，其中１１例经 Ｆ Ｂ成功地钳出异物而治愈。提示 Ｆ Ｂ对被漏诊的支气管异物患者具有重要的诊治价值。

持续慢性呼吸症患儿应怀疑气道异物可能

目的探讨气道异物延误诊断的因素和长时留存气道异物的主要表现。方法回顾性研究自2004年6月~2008年9月在我院行气道异物取出术的患儿,选取异物留存超过30 d患儿作为研究对象行统计分析。结果从2004年6月~2008年9月我院共有1263例气道异物取出术,其中异物留存超过30 d的为107例（8.47%）,农村儿童86例（80.37%）,临床表现主要是反复发热（69例,占64.49%）、慢性咳嗽（62例,占57.94%）和喘鸣（44例,占41.12%）等。结论来自农村气道异物患儿,常因为影像学不典型和基层医生缺乏气道异物意识而误诊,临床表现为慢性呼吸症状和影像学炎症征象。

口腔种植术中误吸螺丝刀病例报道及文献回顾

目的探讨口腔诊疗操作中误吸、误吞的预防措施与治疗方法。方法报道1例种植术中发生误吸的病例,并结合相关口腔诊疗操作中误吸、误吞的文献进行复习。结果该患者行种植义齿修复时,螺丝刀不慎掉落至口中,伴随轻微咳嗽2次。手术医生及助手立即停止操作,于患者口中未寻及。患者无呼吸不畅、胸闷、气短等不适。胃镜检查未见异物,胸部X线与CT检查示左肺下叶金属致密影。局部麻醉下,呼吸内科医生使用支气管镜及配套活检钳夹取异物。取出异物后患者无明显不适,仅有轻微咳嗽,给予口服头孢氨苄、甲硝唑3 d预防感染。文献表明,口腔诊疗操作中发生误吸后应立即停止操作、放平椅位,预防异物进一步下行增加取出难度及造成消化道呼吸道损伤。通过影像学检查确定异物位置,选择相应的手段取出异物。结论口腔诊疗操作中发生误吸、误吞后患者可能无明显不适症状,需要通过影像学检查明确异物位置后取出异物。

儿童呼吸道异物1085例流行病学特征分析

目的分析儿童呼吸道异物的流行病学特征,减少儿童呼吸道异物的发生。方法回顾分析2010～2012年在本院经硬性支气管镜手术治疗的1 085例呼吸道异物患儿的临床资料。结果 1 085例患者中,3岁以下的男性患儿占58.17%;城乡比为1∶2.52;冬春季节发病人数占总发病人数的61.05%;83.59%的患儿在患病24 h后获得有效诊治,其中右侧支气管异物46.57%;坚果类食物占所有吸入异物种类的79.94%;进食哭闹占所有诱发因素的78.43%。结论儿童呼吸道异物的发生具有明显的性别、年龄、城乡、季节分布特征,以坚果类食物为主,常由进食哭闹诱发。依据流行病学特征制订干预策略将有助于降低该类意外事件的发生。

ManujetⅢ手控喷射通气(MJV)用于患儿长时留存气道异物取出术的效果

目的评价ManujetⅢ手控喷射通气(manual jet ventilation,MJV)用于气道异物长时间留存的患儿异物取出术的效果。方法回顾性研究我院自2004年6月至2008年9月气道异物超过30天的患儿,根据术中通气方式分为ManujetⅢ手控喷射通气组(m组)和借硬直喉镜侧孔通气组(n组)进行对照分析。结果术前两组患儿一般情况无明显差异,m组术中低氧发生率低于n组(P=0.03 5,χ2=4.43 1);手术时间(P=0.03 1,t=5.01 6)和苏醒时间(P=0.04 3,t=3.42 6)短于n组。结论 ManujetⅢ手控喷射通气可降低患儿长时间留存的气道异物取出术术中的缺氧发生率、缩短手术及苏醒时间。

口腔疾病治疗中异物的误吸误咽

口腔疾病治疗中难免会发生异物的误吸误咽,这种意外更容易发生在儿童。拔出的牙齿以及根管治疗器械、修复体、正畸矫治器部件等都可能被患者误吸误咽。本文简要介绍了误吸误咽发生的原因、并发症、处理方法和预防措施等方面的内容,以期指导口腔临床工作。

儿童气管支气管异物诊治中应关注的问题

气管支气管异物是儿童耳鼻咽喉头颈外科常见病,具有起病急,病情进展快的特点,严重时可危及生命。本文结合湖南省儿童医院35年气管支气管异物的救治经验,对该病的发展概况、诊断、手术、术后处理、并发症处理及健康教育等方面进行阐述,希望对儿童气管支气管异物的防治工作具有借鉴和参考作用。