Foreign Body Aspiration: The Role of the Pediatric Pulmonologist
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Pulmonologists
Foreign body aspiration
A aspiração de corpo estranho (ACE) para o trato respiratório é um problema comum em pacientes pediátricos, em especial abaixo dos três anos de idade. Na avaliação radiológica inicial, cerca de 30% dos pacientes apresentam radiograma de tórax normal. A tomografia com broncoscopia virtual (BV) pode auxiliar no diagnóstico precoce desse quadro e seu pronto manejo. O tratamento definitivo se dá com a retirada do corpo estranho através de broncoscopia rígida e mediante anestesia geral. O objetivo deste trabalho foi descrever o uso da BV na abordagem de dois pacientes com suspeita de ACE e realizar uma revisão da literatura sobre este tópico. Os dois pacientes tiveram início súbito de sintomas respiratórios e relato de tosse ou engasgo com alimentos antecedendo o quadro. Os pacientes foram submetidos à BV, e foi detectada a presença de corpo estranho endobrônquico em ambos os casos, com remoção posterior por broncoscopia rígida convencional em um caso. A BV é um método não-invasivo recente e com potencial para detectar a presença de corpo estranho na via respiratória em crianças. Em casos selecionados, BV pode auxiliar na localização correta do corpo estranho e até mesmo evitar o procedimento de broncoscopia rígida na ausência de corpo estranho.
Choking
Foreign body aspiration
Rigid bronchoscopy
Flexible bronchoscopy
Foreign Body Removal
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BACKGROUND:
Foreign body aspiration is an uncommon entity in adults. Herein, we describe our experience with flexible bronchoscopy in the removal of tracheobronchial foreign bodies in adults. We also conducted a systematic review of the literature on the topic of foreign body inhalation in adults managed with flexible bronchoscopy.METHODS:
The bronchoscopy database (from 1979 to 2014) was reviewed for subjects > 12 y of age with a history of foreign body aspiration managed with flexible bronchoscopy. Demographic, clinical, and bronchoscopy data were collected and analyzed. PubMed was reviewed for studies describing the use of flexible bronchoscopy for foreign body extraction in adults.RESULTS:
During the study period, a total of 25,998 flexible bronchoscopies were performed. Of these, 65 subjects (mean age of 32.8 y, 49 males) were identified who had undergone bronchoscopy for foreign body aspiration. Nonresolving pneumonia (30.6%), direct foreign body visualization (24.6%), and segmental collapse (18.4%) were the most common radiological abnormalities. Foreign bodies were identified in 49 cases during bronchoscopy and successfully removed in 45 (91.8%) subjects with no major complications. Metallic (41%) and organic (25.6%) foreign bodies were the most common. Shark-tooth (44.9%) and alligator (32.6%) were the most commonly used forceps in retrieving the foreign bodies. The systematic review yielded 18 studies (1,554 subjects with foreign body inhalation). In adults, the proportion of flexible bronchoscopy (6 studies, 354/159,074 procedures) performed for the indication of foreign bodies among the total flexible bronchoscopies was 0.24% (95% CI 0.18–0.31). The overall success of flexible bronchoscopy (18 studies, 1,185 subjects) for foreign body extraction was 89.6% (95% CI 86.1–93.2).CONCLUSIONS:
Foreign body aspiration is a rare indication for flexible bronchoscopy in adults. Flexible bronchoscopy has a high success rate in removal of inhaled foreign body and can be considered the preferred initial procedure for management of airway foreign bodies in adults.Foreign body aspiration
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Flexible bronchoscopy is the most commonly used tool for the diagnosis of foreign body aspiration (FBA) and the preferred instrument for foreign body removal in adults. In children, the most common procedure performed for removal of foreign bodies is rigid bronchoscopy with or without the use of adjuvant flexible bronchoscopy. This chapter reviews the role of flexible bronchoscopy in foreign body removal in both the adult and pediatric populations. The management of foreign body removal is addressed by exploring three different therapeutic approaches: postural drainage, rigid bronchoscopy, and flexible bronchoscopy. The chapter discusses a case study of a previously healthy 34-year-old male found to have an incidental finding of a radiopaque foreign body on the chest radiograph. The foreign body removal procedure was performed in a fully equipped bronchoscopy suite under moderate sedation with intravenous midazolam and morphine.
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Foreign body aspiration is an emergent and potentially life-threatening event. Children and toddlers under 3-5 years are usual victims. Prompt diagnosis with early treatment is essential to prevent serious complications. A 12-year-old boy was treated as asthma for 2 years after an episode of foreign body aspiration. Intractable pneumonia of left lung was developed in spite of the intervention of systemic antibiotics. Computed tomography showed a suspected foreign body with obstruction of left main bronchus. Rigid ventilation bronchoscopy demonstrated a central hollow foreign body lodged in the left main bronchus after suction of thick mucous secretion. Removal of foreign body by grasping forceps was found to be difficult because of deep embedment of foreign body in the bronchial mucosa. We decided to fully utilize the characteristic of foreign body by inserting the forceps into the hollow foreign body, opening the forceps and then pulling the foreign body out of airway. The foreign body was found to be a head-hollow pen cap. The patient was free of cough and chest x-ray showed restoration of pulmonary parenchyma one month after bronchoscopy. The case reminds that school-aged children are not spared to foreign body aspiration. Aspiration of pen cap is possible when school child is biting pen cap with accidental aspiration. Accurate diagnosis and proper removal based on the nature of foreign body can significantly improve clinical symptoms, avoid complications and subsequent salvage operation.
Foreign body aspiration
Foreign Body Removal
Right Main Bronchus
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Assessment of bronchoscopy usefulness for diagnosis and treatment in children suspected of foreign body aspiration.There were 27 boys and 18 girls in the age from 15 month to 14 years (average 5.5 years). Rigid bronchoscopy was performed under general anaesthesia. Assessment of the respiratory tract was done and in cases with foreign body bronchoscopic evacuation was executed. Medical records and video recordings of bronchoscopy procedures were subjected to retrospective analysis.In 28 children (62.2%) during bronchoscopy, foreign body aspiration recognized in 17 (37.8%) bronchoscopy cases was negative. In 27 patients, foreign bodies were removed. In one child, foreign body was evacuated during second bronchoscopy after preparing proper instrumentation. There were no complications in post-bronchoscopic period. Operating time was from 5 to 90 min, average time was noted to be 24 min. Average time of hospital stay was 2-3 days.Aspiration of foreign body should be suspected in all cases of bronchopulmonary infection with atypical course. Bronchoscopy is the best diagnostic and therapeutic method in all suspicions of foreign body. In children rigid bronchoscopy is still the method of choice.
Foreign body aspiration
Foreign Body Removal
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Pulmonologists
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Anterograde amnesia
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Foreign body aspiration
Chest radiograph
Foreign Body Removal
Right Main Bronchus
Left main bronchus
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This chapter contains sections titled: Introduction Risk factors Clinical presentation Types of foreign body Radiologic evaluation Complications of foreign body aspiration Therapeutic approach to the patient with foreign body aspiration Removing an airway foreign body with a flexible bronchoscope References
Foreign body aspiration
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Foreign Body Removal
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Asphyxiation by an inhaled foreign body is a leading cause of accidental death among children younger than three years.The species of foreign body aspiration are many and varied.Immediately after inhalation the child starts to cough,wheeze,or have laboured breathing.The clinical manifestation will be different when foreign body stays in different part of bronchial tree.It's extremely easy to cause misdiagnosis.No matter whether aspiration or not,bronchoscopy should be taken.The bronchoscopy is not only the means of diagnosis,and removes the foreign body at the same time which helps to treat timely.
Key words:
Tracheal foreign body; Flexible bronchoscopy; Rigid bronchoscopy; Children
Foreign body aspiration
Accidental
Wheeze
Foreign Body Removal
Rigid bronchoscopy
Flexible bronchoscopy
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Purpose of review Anesthesia for foreign body removal in children can be quite challenging. Even though rigid bronchoscopy is considered the gold standard for foreign body removal, there is increasing evidence for successful foreign body removal using flexible bronchoscopy. This review discusses the recent implications for flexible bronchoscopy for the purpose of foreign body removal and will compare these findings to rigid bronchoscopy. Recent findings During the last few years, several observational studies on foreign body removal by flexible bronchoscopy have been published, with promising results. Summary Flexible bronchoscopy is a feasible and safe method for removing aspirated foreign bodies in children. In order to improve patient safety during the procedure, it is necessary for a pediatric anesthetist and a pediatric pulmonologist to work closely together. The anesthetist can take care of the administration of the anesthetic and maintenance of the vital functions, and the pulmonologist can carry out a safe and fast bronchoscopy. In the case of foreign body removal by flexible bronchoscopy, the anesthesiological procedure of choice should be general anesthesia with controlled ventilation via a laryngeal mask.
Pulmonologists
Foreign body aspiration
Foreign Body Removal
Flexible bronchoscopy
Rigid bronchoscopy
Gold standard (test)
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