A Multilayer Research to Investigate the Clinical and Statistical Features of Patients for Remote Bodies and Use of Unbending Bronchoscopy (original) (raw)
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Ai rway foreign bodies have been a major cause of morbidity and mortality allover the world. It affects children mostly but adults may be also affected under special conditions. The rigid bronchoscope was used primarily to remove foreign bodies during the first half of the 20th century (in 1897). Training in rigid bronchoscopy for foreign body removal is gaining more importance especially for otolaryngoloists managing pediatric patients. Bronchoscopy in the past was a dangerous procedure with high morbidity and mortality, but recently it is turned into a relatively safe procedure due to the developments in the field of anesthesia and bronchoscopy equipments as optical telescope and solid-rod lens optical systems. Foreign body aspiration sites Foreign bodies may be inhaled and cause respiratory obstruction at different levels. Most end up in peripheral bronchi (80-90%) with the right main stem most common as it has less divergent angle and greater diameter. These anatomical differences are apparent only after the age of 15 years (the bronchial angles are symmetric until 15 years of age). Large and irregularly shaped foreign bodies are more likely to become lodged in the laryngeal inlet.
An experience of 42 cases of bronchoscopy at Saidu Group of Teaching Hospitals, Swat
Journal of Ayub Medical College, Abbottabad : JAMC
The objectives of our study were to find out the frequency in terms of age and sex of the patients, type and site of foreign bodies, clinical manifestations and management with rigid ventilating bronchoscope. It was a descriptive study carried out in the department of otolaryngology and head and neck surgery at Saidu Teaching Hospital swat, and was conducted from March 2005 to March 2006. A total of 42 cases collected from March 2005 to March 2006, admitted through casualty, OPD and referred by pediatric unit. All of them subjected to bronchoscopy as an emergency as well as an elective procedure. A total of 42 cases were included in the study. In 37 cases (88.09%) foreign bodies were removed successfully, while 4 cases (9.52%) were having no foreign body, only mucous plug was removed. One patient (2.32%) died due to cardiac arrest.
CRCM, 2013
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 unit 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 removal 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 constituted 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. Key words: aspirated foreign bodies, fiberoptic bronchoscopy.
The multivariate analysis of indications of rigid bronchoscopy in suspected foreign body aspiration
International Journal of Pediatric Otorhinolaryngology, 2017
Objective: Foreign body aspiration (FBA) could be a serious life-threatening condition in children. Patients usually underwent bronchoscopy with suspicious of FBA alone. In this study, we aimed to determine which patients need to go to bronchoscopy based on pre-operative findings. Methods: Retrospective analysis of patients underwent bronchoscopy between 1999 and 2015 was performed. Clinical symptoms, witnessed aspiration event (WAE), physical examination findings (PEFs) and radiological findings (RFs) were analyzed by multivariate analysis to evaluate the indications of bronchoscopy. Results: 431 patients (266M, 165F) underwent bronchoscopy with a median age of 2 years (7 months-16 years). A foreign body was detected in 68% of the patients. Univariate analysis demonstrated that wheeze was the sole distinctive clinical symptom for detection of FBA (p<0.001). The rates of positive WAE, PEFs and RFs were 83%, 71.7% and 36.9%, respectively. All of them were identified as independent predictive parameters in the detection of FBA by univariate analysis (p ¼ 0.003&p<0.001&p ¼ 0.015). Multivariate analysis was performed with considering the association between them. The rate of positive bronchoscopy was 91.3% in patients with positive WAE, PEFs and RFs together(84/92). In patients with a positive WAE alone who had not got PEFs and RFs, the rate of positive bronchoscopy was 34.2% (25/73). A foreign body was detected in 84% of the patients who had not got a WAE but positive PEFs and RFs together(21/25). Bronchial laceration was occurred in one patient during bronchoscopy. Pneumothorax was not seen in any of the other patients. The rate of mortality was 0.4% in the overall group (2 patients). Conclusion: The indications of bronchoscopy in suspected FBA are usually based on clinical suspicious. The definition of " suspicous" could be a WAE or positive PEFs and RFs. The association of these factors increase the rate of positive bronchoscopies. In the light of our study, the classical indication for suspected FBA is still valid as "suspicious requires bronchoscopy".
Is Early Diagnosis of Foreign Body Aspiration Effective in Reducing Re-bronchoscopy in Children?
2021
Background:Flexible Fiber-optic Bronchoscopy (FFB) is a diagnostic and therapeutic tool for respiratory diseases and evaluation. One of its major advantages is in the diagnosis and treatment of foreign body aspiration.Objectives:This study reports the indications, outcomes, and possible complications of FFB in patients suspected of foreign body aspiration diagnosis in the Iranian population.Methods:The data for this study was gathered from medical records of the patients in Children’s Medical Centre, which is a tertiary pediatric hospital affiliated with Tehran University of Medical Sciences (TUMS), from August 2015 to February 2021.Results:Of the 358 FFBs that were performed for patients suspected of foreign body aspiration diagnosis, major indications included choking (158, 44.13%), coughing (157, 43.58%), wheezing (34, 9.49%), and stridor (6, 1.67%). Nuts were the most common foreign body that was removed among airways in these patients (116, 65.16%). In 15 (4.18%) cases the fore...
Rigid bronchoscopy for the suspicion of foreign body in the airway
International Journal of Pediatric Otorhinolaryngology, 2006
Objective: Airway foreign bodies present a diagnostic dilemma and has been recognized for many years. Since aspiration of foreign bodies can be a serious and sometimes fatal problem, early intervention and proper management is vital. Method: In this retrospective study, the results of 1887 bronchoscopies, which were performed between the years 1973 and 2004 for the suspicion of foreign body aspiration in children, were presented. Various instruments and techniques were used over 31-year period and rigid bronchoscopy was the preferred method of foreign body exctraction. Results: There were 1106 boys and 781 girls with the median age of 2.3 years. Seventy-four percent of patients were less than 3 years old. The most common type of foreign body (89.9%) was organic; watermelon seeds (39.7%) were the most frequent organic foreign bodies. Eight hundred and twenty-three patients (43.6%) were referred to our clinic within the first 24 h of the event while 4.5% of the patients were admitted to the hospital with the suspicion of foreign body in the airway later than one month. At bronchoscopy, a foreign body was identified in 79.1% of patients and no foreign body was seen in 20.9% of patients. Foreign bodies were encountered in 96.3% of the patients with positive history whereas 28.1% of the patients with negative history had foreign body. Of the patients with foreign bodies, 93.2% had positive history. Overall, the positive history was obtained from 85.2% of patients. The incidence of postbronchoscopic tracheotomy, thoracotomy, and overall mortality rate were 0.47, 0.15, and 0.21%, respectively. Conclusion: Otolaryngologists should consider foreign body aspiration in the airway in the differential diagnosis of any patient with the complaints of stridor, dyspnea, sudden onset of cough and intractable and recurrent lower respiratory tract infections. A careful history and physical examination were strong indicators of the * Corresponding author.
Bronchoscopy, indications, safety and complications
Saudi medical journal
lexible fiber optic bronchoscopy (FFB) was introduced by S. Ikeda in 1964. Since then bronchoscopy has become an important diagnostic and therapeutic tool for management of chest disease. The indications of bronchoscopy are numerous and usually based on the presence of respiratory symptoms and abnormal chest radiograph or both. 1 Common indications include peripheral pulmonary nodule, hemoptysis, chronic cough, pleural effusion, recent or unresolved pneumonia, pulmonary tuberculosis, and lung collapse. 2-9 Bronchoscopy can be used in the intensive care units as an aid for intubation, positioning of double lumen tubes for surgery, and in the diagnosis of ventilation-Objectives: To review the safety, indications, complications of flexible fiberoptic bronchoscopies performed at university teaching hospital, and to correlate the bronchoscopic findings with radiology, histology, and history of smoking.