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Foreign Body Aspiration in Children and Emergency Rigid Bronchoscopy: A Retrospective Observational Study

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Abstract

Foreign body aspiration is potentially life-threatening in paediatric age group. Early recognition and emergency intervention by Rigid bronchoscopy is life-saving. To highlight various difficulties in emergency paediatric bronchoscopy and discuss our experience in 138 patients. < 12 years children with suspected foreign body aspiration were included. Data of 138 patients < 12 years of age were studied. The most common foreign body found was peanut and organic foreign bodies constituted of total foreign bodies removed. Choking, Cough and sudden onset breathlessness were common symptoms. Tachypnoea, asymmetric breath sound, rhonchi, stridor, reduced chest movements were common signs. Obstructive emphysema was commonest radiological findings. Majority of the patients were discharged within 72 h & only two patients expired. History, clinical and radiological findings are highly indicative of foreign body in the airway. Inspite of being a high risk procedure, Rigid bronchoscopy when performed with necessary expertise,trained anaesthesia team and a paediatric ICU, saves majority of lives of children with tracheobronchial foreign bodies.

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References

  1. Watkinson JC, Clarke RW (eds), Scott-Brown’s otorhinolaryngology head & neck surgery. 8th Ed. Vol 1. chapter 34. p 364; CRC press, Taylor & Francis Group, Boca Raton, US

  2. McGuirt WF, Holmes KD, Feehs R, Browne JD (1988) Affiliation. Tracheobronchial foreign bodies. Laryngoscope 98(6 Pt 1):615–618. https://doi.org/10.1288/00005537-198806000-00007

    Article  CAS  PubMed  Google Scholar 

  3. Beamis JF, Mathur P, Mehta AC McGraw Hill, New York 1999:17–28. Interventional pulmonary medicine (Lung Biology in Health and Disease Book 189)

  4. Turner JF, Ernst A, Becker HD (2000) Rigid bronchoscopy: how I do it. J Bronchol 7(2):171–176

    Article  Google Scholar 

  5. Elias J, Fishman J, Pack A, Senior R, Kotloff R (1997) Fishman’s pulmonary diseases and disorders by michael grippi. McGraw Hill, New York, pp 589–602

    Google Scholar 

  6. Ramon P, Brichet A (1999) Complications of interventional bronchoscopy. Rev Mal 16:693–698

    CAS  Google Scholar 

  7. Rothmann BF, Boeckman CR (1980) Foreign bodies in the larynx and tracheobronchial tree in children. Ann Otol Rhinol Laryngol 89(51):434–436. https://doi.org/10.1177/000348948008900512

    Article  CAS  PubMed  Google Scholar 

  8. Zahran M, Youssef A (2019) The role of rigid bronchoscopy in pediatric foreign body aspiration. Egyptian J Otolaryngol 35(2):213–218. https://doi.org/10.4103/ejo.ejo_61_18

    Article  Google Scholar 

  9. Sinha V, Gurnani D, Barot DA (2014) A study of applications of rigid bronchoscopy in pediatric patients. Indian J Otolaryngol Head Neck Surg 66(2):142–144. https://doi.org/10.21037/jtd.2016.11.87

    Article  PubMed  Google Scholar 

  10. Naragund AI, Mudhol RS, Harugop AS, Patil PH, Hajare PS, Metgudmath VV (2011) Tracheo-bronchial foreign body aspiration in children: a one year descriptive study. Indian J Otolaryngol Head Neck Surg 66(Suppl.1):180–185. https://doi.org/10.1007/s12070-011-0416-2

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cramer N, Jabbour N, Tavarez MM et al. (2018) Foreign body aspiration. Review from Stat Pearls publishing, Treasure Island (FL). PMID 30285375

  12. Sehgal A, Singh V, Chandra J, Mathur NN (2002) Foreign body aspiration. Indian Paediatrics 39:1006–1016

    Google Scholar 

  13. Tan HK, Brown K, McGill T, Kenna MA, Lund DP, Healy GB (2000) Airway foreign bodies (FB): A 10-year review. Int J Paediatr Otorhinolaryngol 56(2):91–99. https://doi.org/10.1016/S0165-5876(00)00324-4

    Article  CAS  Google Scholar 

  14. Even L, Heno N, Talmon Y, Samet E, Zonis Z, Kugelman A (2005) Diagnostic evaluation of foreign body aspiration in children: a prospective study. J Paediatr Surg 40(7):1122–1127. https://doi.org/10.1016/j.jpedsurg.2005.03.049

    Article  Google Scholar 

  15. Mallick MS (2014) Tracheobronchial foreign body aspiration in children: a continuing diagnostic challenge. Afr J Paediatr Surg 11(3):225–228. https://doi.org/10.4103/0189-6725.137330

    Article  PubMed  Google Scholar 

  16. Soysal O, Kuzucu A, Ulutas H (2006) Tracheobronchial foreign body aspiration: a continuing challenge. Otolaryngol Head Neck Surg 135(2):223–226. https://doi.org/10.1016/j.otohns.2005.09.035

    Article  PubMed  Google Scholar 

  17. Zerella JT, Dimler M, McGill LC et al (1998) Foreign body aspiration in children: value of radiography and complications of bronchoscopy. J Paediatr Surg 33(11):1651–1654. https://doi.org/10.1016/s0022-3468(98)90601-7

    Article  CAS  Google Scholar 

  18. Svedstrom E, Puhakka H, Kero P (1989) How accurate is chest radiography in the diagnosis of tracheo-bronchial foreign bodies in children? Pediatr Radiol 19:520–522. https://doi.org/10.1007/BF02389562

    Article  CAS  PubMed  Google Scholar 

  19. Mu L, He P, Sun D (1991) Inhalation of foreign bodies in Chinese children: a review of 400 cases. Laryngoscope 101(6):657–660. https://doi.org/10.1288/00005537-199106000-00014

    Article  CAS  PubMed  Google Scholar 

  20. Tokar B, Ozkan R, Ilhan H (2004) Tracheobronchial foreign bodies in children: importance of accurate history and plain chest radiography in delayed presentation. Clin Radiol 59(7):609–615. https://doi.org/10.1016/j.crad.2004.01.006

    Article  CAS  PubMed  Google Scholar 

  21. Rovin JD, Rodgers BM (2000) Pediatric foreign body aspiration. Pediatr Rev 21(3):86–90. https://doi.org/10.1542/pir.21-3-86

    Article  CAS  PubMed  Google Scholar 

  22. Paşaoğlu I, Doğan R, Demircin M, Hatipoğlu A, Bozer AY (1991) Bronchoscopic removal of foreign bodies in children: retrospective analysis of 822 cases. Thoracic Cardiac Surg 39(2):95–98. https://doi.org/10.1055/s-2007-1013940

    Article  Google Scholar 

  23. Yadav SP, Singh J, Aggarwal N, Goel A (2007) Airway foreign bodies in children: experience of 132 cases. Singapore Med J 48(9):850–853

    CAS  PubMed  Google Scholar 

  24. Cotton E, Yasuda K (1984) Foreign body aspiration. Paediatr Clin North Am 31(4):937–941. https://doi.org/10.1016/s0031-3955(16)34655-7

    Article  CAS  Google Scholar 

  25. Oğuzkaya F, Akçali Y, Kahraman C, Bilgin M, Sahin A (1998) Tracheobronchial foreign body aspirations in childhood: a 10-year experience. Eur J Cardiothoracic Surg 14(4):388–392. https://doi.org/10.1016/s1010-7940(98)00205-x

    Article  Google Scholar 

  26. Hasdiraz L, Oguzkaya F, Bilgin M, Bicer C (2006) Complications of bronchoscopy for foreign body removal: experience in 1,035 cases. Ann Saudi Med 26(4):283–287. https://doi.org/10.5144/0256-4947.2006.283

    Article  PubMed  PubMed Central  Google Scholar 

  27. Banerjee A, Rao KS, Khanna SK, Narayanan PS, Gupta BK, Sekar JC (1988) Laryngo-tracheo-bronchial foreign bodies in children. J Laryngol Otol 102(11):1029–1032. https://doi.org/10.1017/s0022215100107170

    Article  CAS  PubMed  Google Scholar 

  28. Ülkü R et al (2005) The value of open surgical approaches for aspirated pen caps. J Paediatr Surg 40(11):1780–1783. https://doi.org/10.1016/j.jpedsurg.2005.07.028

    Article  Google Scholar 

  29. Marks SC et al (1993) Indications for open surgical removal of airway foreign bodies. Ann Otol Rhinol Laryngol 102(9):690–694. https://doi.org/10.1177/000348949310200908

    Article  CAS  PubMed  Google Scholar 

  30. Yang X, Ni X, Guo Y, Zhang J (2018) Combined low tracheotomy and rigid bronchoscopy to remove an irregular tracheal foreign body. Paediatric Invest 2(3):196–197. https://doi.org/10.1002/ped4.12059

    Article  Google Scholar 

  31. Bittencourt PFS, Camargos PAM (2006) Foreign body aspiration: clinical, radiological findings and factors associated with its late removal. Int J Paediatr Otorhinolaryngol 70(5):879–884. https://doi.org/10.1016/j.ijporl.2005.09.024

    Article  Google Scholar 

  32. Girardi G, Contador AM, Castro-Rodriguez JA (2004) Two new radiological findings to improve the diagnosis of bronchial foreign-body aspiration in children. Pediatr Pulmonol 38(3):261–264. https://doi.org/10.1002/ppul.20065

    Article  PubMed  Google Scholar 

  33. Hua H, Na L, Zhijun CJ, Fugao ZG, Yan S, Niankai ZK et al (2008) Therapeutic experience from 1428 patients with pediatric tracheobronchial foreign body. J Paediatr Surg 43(4):718–721. https://doi.org/10.1016/j.jpedsurg.2007.10.010

    Article  Google Scholar 

  34. Barrios Fontoba JE, Gutierrez C, Lluna J, Vila JJ, Poquet J, Ruiz-Company S (1997) Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis? Pediatr Surg Int 12:118–120. https://doi.org/10.1007/BF01349976

    Article  CAS  PubMed  Google Scholar 

  35. Baharloo F, Veyckemans F, Francis C, Biettlot M-P, Rodenstein DO (1999) Tracheobronchial foreign bodies: presentation and management in children and adults. Chest 115(5):1357–1362. https://doi.org/10.1378/chest.115.5.1357

    Article  CAS  PubMed  Google Scholar 

  36. Hoeve LJ, Rombout J, Pot DJ (1993) Foreign body aspiration in children. The diagnostic value of signs, symptoms and pre-operative examination. Clin Otolaryngol Allied Sci 18(1):55–57. https://doi.org/10.1111/j.1365-2273.1993.tb00810.x

    Article  CAS  PubMed  Google Scholar 

  37. Fazal-I-Wahid N, Ur-Rehman H, Amin G, Ahmad I (2011) Rigid Bronchoscopy for extraction of foreign bodies tracheobronchial tree: an experience of 232 cases. JPMI 25(2):152–157

    Google Scholar 

  38. Lemberg PS, Darrow DH, Hollinger LD (1996) Aerodigestive tract foreign bodies in the older child and adolescent. Ann Otol Rhinol Laryngol 105(4):267–271. https://doi.org/10.1177/000348949610500404

    Article  CAS  PubMed  Google Scholar 

  39. Emir H, Tekant G, Beşik C, Eliçevik M (2001) Bronchoscopic removal of tracheobroncheal foreign bodies: value of patient history and timing. Paediatr Surg Int 17:85–87. https://doi.org/10.1007/s003830000485

    Article  CAS  Google Scholar 

  40. Perrin G, Colt HG, Martin C et al (1992) Safety of interventional rigid bronchoscopy using intravenous anesthesia and spontaneous assisted ventilation: a prospective study. Chest 202:1526–1530. https://doi.org/10.1378/chest.102.5.1526

    Article  Google Scholar 

  41. Hanowell LH, Martin WR (1991) Complications of general anesthesia for Nd:YAG laser resection of endobronchial tumors. Chest J. https://doi.org/10.1378/chest.99.1.72

    Article  Google Scholar 

  42. Dumon JF, Shapshay S, Bourcereau J, Cavaliere S, Meric B, Garbi N, Beamis J (1984) Principles for safety in application of neodymium-YAG laser in bronchology. Chest 86(2):163–168. https://doi.org/10.1378/chest.86.2.163

    Article  CAS  PubMed  Google Scholar 

  43. Miligan KR, Howe JP, O’Toole DP et al (1987) Outpatient anaesthesia: recovery after propofol, methohexitol and thiopental. Anaesthesia Analgesia 66(2):s118

    Article  Google Scholar 

  44. Aydogan LB, Tuncer U, Soylu L et al (2006) Rigid bronchoscopy for the suspicion of foreign body in the airway. Int J Paediatr Otolaryngol 70(5):823–828. https://doi.org/10.1016/j.ijporl.2005.09.010

    Article  Google Scholar 

  45. Roberts CA et al (2018) Morbidity and mortality in children undergoing bronchoscopy for foreign body removal. Laryngoscope 128(5):1226–1229. https://doi.org/10.1002/lary.26817

    Article  PubMed  Google Scholar 

  46. Divarci E, Toker B, Dokumcu Z, Musayev A, Ozcan C, Erdener A (2017) The multivariate analysis of indications of rigid bronchoscopy in suspected foreign body aspiration. Int J Paediatr Otorhinolaryngol 100:232–237. https://doi.org/10.1016/j.ijporl.2017.07.012

    Article  CAS  Google Scholar 

  47. Fidkowski CW, Zheng H, Firth P (2010) The anesthetic considerations of tracheobronchial foreign bodies in children: a literature review of 12,979 cases. Anesthesia Analgesia 111(4):1016–1025. https://doi.org/10.21037/jtd.2016.12.69.2101

    Article  PubMed  Google Scholar 

  48. Latifi X, Mustafa A, Hysenaj Q (2006) Rigid tracheobronchoscopy in the management of airway foreign bodies: 10 years experience in Kosovo. Int J Pediatr Otorhinol 70(12):2055–2059. https://doi.org/10.1016/j.ijporl.2006.07.017

    Article  Google Scholar 

  49. Ernst A, Simoff M, Ost D et al (2008) Prospective risk-adjusted morbidity and mortality outcome analysis after therapeutic bronchoscopic procedures: results of a multi-institutional outcomes database. Chest 134(3):514–519. https://doi.org/10.1378/chest.08-0580

    Article  PubMed  Google Scholar 

  50. Zhang J, Zhang Y et al. (2004) How to reduce the incidence of complications and mortality in Paediatric tracheobronchial foreign body patients. Zhonghua Er B, Yan Hou Ke Za Zhi [Article in Chinese] 39(11): 658–662. PMID 15835815

  51. Reilly J, Thompson J, MacArthur C et al (1997) Pediatric aerodigestive foreign body injuries are complications related to timeliness of diagnosis. Laryngoscope. https://doi.org/10.1097/00005537-199701000-00006

    Article  PubMed  Google Scholar 

  52. American Academy of Paediatrics (1997:91) Guidelines for health supervision III. 3rd Ed ELK Grove village III: American Academy of Paediatrics

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Authors and Affiliations

  1. Institute of OtoRhinoLaryngology and Head Neck Surgery, IPGME and R, 244 A.J.C. Bose Road, Kolkata, 700020, West Bengal, India

    Debasish Ghosh, Sripurna Mondal, Soutrik Kumar & Arunabha Sengupta

  2. Department of Respiratory Medicine, IPGME and R, Kolkata, 700020, India

    Ritabrata Mitra

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  1. Debasish Ghosh
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Ghosh, D., Mitra, R., Mondal, S. et al. Foreign Body Aspiration in Children and Emergency Rigid Bronchoscopy: A Retrospective Observational Study. Indian J Otolaryngol Head Neck Surg 75, 1533–1541 (2023). https://doi.org/10.1007/s12070-023-03628-1

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