Management of Respiratory Foreign Body- A Twelve Years Experience with 382 Cases (original) (raw)
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Airway foreign bodies: our six years' experience with 301 cases
International Journal of Contemporary Pediatrics, 2016
Foreign body aspiration (FBA) is a common problem in children and accounts for an important cause of morbidity and mortality. It is potentially life threatening event and may also cause chronic lung injury if not properly managed in time. 1-4 The diagnosis and the treatment of the tracheobronchial FBs require awareness about the problem and highest degree of suspicion of signs and symptoms. 5-7 The most important concern is the timely diagnosis and safe and speedy removal of the foreign bodies from the airway. 3,7 The accurate diagnosis may be missed by treating physician because often the initial choking episode is not witnessed and the delayed residual symptoms may mimic other common conditions such as asthma, recurrent pneumonia or upper respiratory infection. 3,8,9 The symptoms and signs produced depend upon the nature, size, location and time since lodgment of the foreign body in the tracheo bronchial tree. A large foreign body occluding the upper airway may lead to ABSTRACT Background: Foreign body aspiration (FBA) is a common problem in children and accounts for an important cause of morbidity and mortality. The main objective of this study was to evaluate the clinico-demographic profile and management of foreign body (FB) aspiration in hospitalized patients. Methods: This was a retrospective study conducted at Indira Gandhi institute of child health, Bangalore during the period from January to December 2015. All patients who gave a history of FBA or suspected of FB aspiration, those who had recurrent chest infection and who had undergone bronchoscopy were included in the study. Medical records were used for data collection of cases recurrent chest infections. The diagnosis of FBA was made from the documented clinical presentations, physical findings and investigations like chest X ray, CT scan whenever done. The management included rigid bronchoscopy and surgical interventions like tracheotomy, thoracotomy with bronchotomy and thoracoscopic retrieval. Results: Most of the patients were in the age group between 1 to 3 years 206 (68%). Males were more affected 217 (72%) than females 84 (27.9%). 290 patients (96.3%) presented early (within 7 days of aspiration) with cough and respiratory distress. FBs were found impacted in the right bronchial tree more commonly, 195 (82.2%), followed by left bronchial tree in 30 (12.6%) and in the trachea 8 (3.3%) cases. In failed bronchoscopy cases, other surgical modalities like tracheotomy, laryngotomy, bronchotomy, thoracoscopic retrieval were attempted. Conclusions: Children of the age group 1-3 years were found most vulnerable for FB aspiration. FBs were mostly vegetative and were found mostly in the right bronchial tree. Removal of FB by rigid bronchoscopy was safe and effective when patients presented early. Surgical modalities of management like tracheotomy, laryngotomy, bronchotomy were needed in cases of late presentation.
African Journal of Paediatric Surgery, 2014
Background: There is paucity of data regarding the morbidity and mortality of rigid bronchoscopy in children for foreign body (FB) retrieval from India. The aim was to audit data regarding anaesthetic management of rigid bronchoscopy in children and associated morbidity and mortality. Materials and Methods: Hospital records of all patients below 18 years of age undergoing rigid bronchoscopy for suspected FB aspiration (FBA) between January 1, 2002 and December 31, 2011 were audited to assess their demographic profile, anaesthetic management, complications, and postoperative outcomes. The children were divided into early and late diagnosis groups depending on whether they presented to the hospital within 24 hours of FBA, or later. Results: One hundred and forty children, predominantly male (75%), with an average age of 1-year and 8 months, presented to our hospital for rigid bronchoscopy during the study period. Majority of children presented in the late diagnosis group (59.29% vs. 40.71%). The penetration syndrome was observed in 22% of patients. Majority of patients aspirated an organic FB (organic: Inorganic FB = 3:1), with peanuts being the most common (49.28%). A significantly higher number of children presented with cough (P = 0.0001) and history of choking (P = 0.0022) in the early diagnosis group and crepitations (P = 0.0011) in the late diagnosis group. Major complications included cardiac arrest (2.1%), pneumothorax (0.7%), and laryngeal oedema (9.3%). The average duration of hospitalization in our series was 3.08 ± 0.7 days. Conclusions: Foreign body aspiration causes considerable morbidity, especially when diagnosis is delayed.
2020
Background: Foreign body aspiration commonly occurs in young children and is associated with high degree of mortality and morbidity. The objectives of this study were to determine epidemiologic, clinical and endoscopic perspectives of foreign body aspiration in children of District D.I.Khan, Pakistan. Materials & Methods: This descriptive study was conducted in Department of ENT, Gomal Medical College/ DHQ Teaching Hospital, D.I.Khan, Pakistan from November 2017-April 2019. 105 children with suspected foreign body (FB) aspiration were included. All patients underwent rigid bronchoscopy under GA. After check X-ray and one day observation, they were discharged. Variables were sex, age in years and age groups, successful removal, mortality, history of FB aspiration, cough, wheezing, choking, stridor, reduced air entry and location of FB. Age in years was numeric, age groups ordinal and all other variables were on nominal scale. Age in years was described by mean & SD and others by coun...
Case series of foreign body aspiration in Paediatric Institute, Hospital Kuala Lumpur
The Medical journal of Malaysia, 2011
A retrospective case series was conducted to determine the clinical characteristics and bronchoscopy findings of children with foreign body aspiration in Paediatric Institute, Hospital Kuala Lumpur. Ten boys and two girls were included (range 2-177 months; median 26 months old). They commonly presented with cough (12/100%) and difficulty in breathing (9/75%). All patients had unilateral auscultatory findings and the commonest radiographic findings were unilateral hyperinflation (7/58.3%). The majority of foreign bodies removed was organic (8/66.6%) and more frequently found in the left bronchial tree (7/58.3%). Major complications were pneumonia (11/91.6%) and airway oedema (11/ 91.6%). Eight patients had delayed diagnosis due to parents unawareness (6/50%) and missed diagnosis (2/16.7%).
Background Foreign body aspiration is one of the leading causes of childhood morbidity and mortality among older infants and toddler age groups. Missed and delayed diagnosis of foreign body aspiration can lead to increased incidence of complications. Early diagnosis can prevent life-threatening complications and morbidity. In this study, we aimed to evaluate the clinical and radiological details, types, localization of foreign bodies, complications, and outcomes in pediatric patients who presented to our hospital with foreign body aspiration. Methodology We conducted a retrospective analysis of hospital case records of children aged one month to 14 years who were admitted to the Department of Pediatrics between June 2018 and May 2020, with clinical suspicion of foreign body aspiration. Results A total of 22 children with a diagnosis of airway foreign body were included. The mean age of presentation was three years (SD: ±2.22), with a boy-to-girl ratio of 3.4:1. Cough (81.8%) and tachypnea (72.7%) were the most common clinical symptoms. The median duration between symptom onset and diagnosis was three (interquartile range: 6) days. Unilateral reduced breath sound (81.8%) was the most common clinical examination finding. The common site of impaction was the right main bronchus in 59.1% of cases. The foreign bodies retrieved during bronchoscopy were organic substances in 63.6% of cases, with peanuts being the most common (31.8%). Chest radiographs were normal in 36.3% of cases, and common abnormalities included hyperinflation, collapse, consolidation, and mediastinal shift. Mechanical ventilation was required in 54.5% of cases. The mean duration of hospitalization was five (SD: ±2.84) days. Complications such as pneumothorax were seen in one (4.5%) case. Mortality was seen in 4.54% of cases during the bronchoscopic procedures. Conclusions Foreign body aspiration was common in young male children, with cough being the common symptom. Normal X-rays of the chest were seen in one-third of cases. The common site of impaction was the right main bronchus, and organic substances such as peanuts were common foreign bodies retrieved. Strong clinical suspicion of foreign body aspiration should be kept in cases with acute onset of cough in young children. Prompt medical attention is needed to reduce the morbidity and mortality associated with foreign body aspiration.
Bangladesh journal of endosurgery, 2013
Background: Foreign body aspiration is a common cause of pulmonary complications and accidental death in children. A high index of suspicion and an early bronchoscopy are essential for the removal of an aspirated foreign body to prevent morbidity and mortality. Methods: This is a retrospective audit of the cases of aspirated foreign bodies in children up to 15 years of age managed in our unit over a 16-year period from 1st February 1995 to 31st January 2011. Results: There were 37 children with the diagnosis of foreign body aspiration during this period. Twenty-seven of these children resided between 50 and 200 km from our hospital. The age ranged from 14 months to 14 years. Twenty-one of these patients presented with an acute onset of respiratory distress without a history of choking. A radioopaque foreign body was visible only in 13 children. In 14 patients, the chest radiograph was normal. The foreign bodies were removed by rigid bronchoscopy. In 29 out of the 37 children the foreign body was non-food product. One patient had a tension pneumothorax and surgical emphysema which settled with a chest drain. Conclusion: An early bronchoscopy, done by a competent surgeon with a rigid bronchoscope deals effectively with the problem of aspirated foreign body, with minimum morbidity. The ability to safely remove an aspirated foreign body is an essential skill to be acquired as part of the training of paediatric surgeons in the developing world.
Foreign body aspiration: a four-years experience
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2003
Foreign bodies (FB) in the airway require prompt removal in children. We reviewed our experience in patients with suspected airway FB. A retrospective study was conducted in 189 consecutive children who admitted to the Department of Pediatric Surgery, SSK Tepecik Training Hospital between 1997-2001. Patients data on presentation, bronchoscopy findings and results were obtained. Of the 189 bronchoscopies, 127 (67.2%) showed FB which are commonly located in the right mainstem bronchus. Most of FB were nonradiopaque. Pips and hazelnuts were the most common FB. Mean hospital stay was 2.5 days. Many patients (151 out of 189; 79.9%) had transient stridor or fever that ceased within 24 hours after bronchoscopy. No mortality was observed rin relation with bronchoscopy. Chest radiographs of the children with FB in the airways are inconclusive. Children with a history of small particles in their mouths and subsequently showing wheezing, or choking episode should undergo prompt bronchoscopy. C...
Journal of Evidence Based Medicine and Healthcare, 2021
BACKGROUND Foreign body aspiration (FBA) in children is one of the major causes of death in developing countries, the diagnosis of which can be missed due to varied presentation. It is one of the causes of choking among children which, if not recognized early may lead to fatal consequences. Early recognition and prompt intervention may reduce the mortality and morbidity. In this study, we wanted to assess the clinical profile of children with foreign body aspiration/ingestion, determine the nature and location of foreign body and also determine the outcome among children with foreign body aspiration at a tertiary care centre. METHODS This cross-sectional study was taken up to analyse the clinical profile, to study the types, location and the outcome of children with foreign body aspiration. All children in the age group of 2 months to 12 years admitted to Niloufer hospital, Hyderabad from January 2018 to December 2019 with either history of FBA or clinical features suggestive of FBA even in the absence of history were included in the study. Age, sex, clinical features (C/F), duration of illness were noted. A chest X-ray was done in all cases, whereas a computed tomography (CT) scan was done in children where clinical features & chest X-rays were inconclusive. All children fulfilling the inclusion criteria were subjected to bronchoscopy under general anaesthesia by ENT surgeons. The findings like type and location of the foreign bodies were noted. Statistical analysis was done by statistical package for social sciences (SPSS) software version 10.0. RESULTS Of 108 children studied, 60 % of cases were males and 40 % were females. 55 % of cases were below the age of 3 years. Common symptoms were rapid breathing (68 %) and cough (38.8 %). Nuts & seeds were the common foreign bodies seen in 47.30 %, out of which groundnuts were the most common. Organic foreign bodies accounted for 58.11 % while inorganic was 41.89 %. The common site of lodgement of foreign body was right main bronchus (35.59 %), followed by left main bronchus (27.11 %) and sub-glottis (8.47 %). CONCLUSIONS Foreign body aspiration is difficult to diagnose in children and a delay in diagnosis can lead to mortality and morbidity. Early intervention by bronchoscopy goes a long way in improving survival. Clinical suspicion is the key to the diagnosis.
Tracheo-bronchial foreign bodies presentation, diagnosis management at tertiary care center
IP innovative publication pvt. ltd, 2019
Introduction: The aim of this work was to study the clinical presentation of tracheo-bronchial foreign body aspiration in children for early diagnosis and prompt treatment. This article attempts to address the potential hazards of foreign body aspiration in children and its subsequent management. Materials and Methods: This is a prospective study of 63 cases in age group of 1 to 8 years that underwent Rigid Bronchoscopy for suspected tracheo-bronchial FB over a period of three years in the ENT Dept. of Venkateshwara Institute of Medical sciences. Cases presented in ENT OPD or referred from emergency/department of paediatrics, with history/ suspicion of foreign body aspiration, with sudden breathlessness, sudden onset of cough with or without cyanosis/ pyrexia were included in the study. Results: In our study, mean age of patients presenting with foreign body aspiration is 2.4 years. Males (57.1%) presented with foreign body aspiration more frequently as compared to females (42.9%). In 62% cases, there was definite history of foreign body ingestion observed by parents or relatives. Maximum no. of patients presented with sudden onset of cough 38%, followed by sudden onset difficulty in (17.4%), noisy breathing (14.2%), hoarseness of voice(11.2%), vomiting and retching (11.2%), 7.9% patients presented with drooling of saliva(7.9%). In our study majority of FB in air passage were in left main bronchus 54% followed by right main bronchus 36.5% and 6.3% in carina. Conclusion: Tracheo-bronchial foreign body aspiration is common in children. Foreign body aspiration may present as un-witnessed episode and a high index of suspicion, even in absence of a positive history, it is necessary to prevent morbidity and mortality due to delayed or misdiagnosis. Foreign body aspiration is an emergency and should be removed by rigid bronchoscopy at the earliest to prevent fatal complications.