Management of foreign body aspiration - a nation-wide survey

BACKGROUND/AIMS:In 1897 Gustav Kilian first described the classic management of foreign body (FB) aspiration in childhood by rigid bronchoscopy. Owing to the widespread employment of flexible bronchoscopy and the advancement of flexible instruments, rigid bronchoscopy has become less frequently utilized in daily clinical routine. In order to get an overview on current practice in our country, Germany, we planned a nation-wide survey on the management of FB aspiration in children, especially regarding the choice of methods for confirmation of the suspected diagnosis, and for FB removal. In addition, we wanted to learn about complications that occurred during the procedures.METHODS:An online survey was designed. We called all paediatric hospitals to identify the person in charge for bronchoscopy. These doctors (n=170) were invited to participate, together with anaesthetists (n=1361), ENT surgeons (n=162), and internists (n=3093) who were contacted by their specific medical associations. After 2 months a reminder questionnaire was sent out. RESULTS:255 questionnaires were returned (n= 29,9 % paediatric, 50,8 % anaesthetists, 0,4 % surgeons, 11,4 % Otolaryngologists, 3,9 % internists, 3,5% others). For confirmation of FB aspiration, the majority of colleagues (74,1%) preferred flexible bronchoscopy. For FB removal 49,2% preferred rigid bronchoscopy, while 20% preferred flexible bronchoscopy; 30% routinely use a combination of rigid and flexible.CONCLUSION:Both flexible and rigid bronchoscopies are valid methods playing an important role in management of FB aspiration in children in our country. From a clinical point of view, we propose that both techniques should be available at a paediatric pulmonary centre.