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Tracheobronchial foreign body aspirations may cause cardiopulmonary arrest and sudden death.The incidence in children is higher than in adults.Rapid diagnosis and treatment are live saving.In this paper, we aimed to present our experience in tracheal foreign body aspirations by fiberoptic bronchoscopy.
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OBJECTIVE: To explore the clinical characteristics,diagnosis and treatment of tracheobronchial foreign body in children and analyze the risk factors for granuloma formation. METHODS: A retrospective analysis of 228 children diagnosed withtracheobronchial foreignbody was carried out,who were treated between January 2011 and December 2017,and the binary Logistic regression on risk factors of secondary airway intimal granulation after tracheobronchial foreign body was done.RESULTS: The high incidence age of tracheobronchial foreign body in children was 1～3 years old(76.3%),and the ratio of male to female was 2.3∶1. The plant foreign bodies were the main proportion(82.9%),and the foreign bodies in left lung(52.6%)was slightly higher than in the right lung(39.5%). Endotracheal granulation(74.4%),pneumonia(76.3%)and emphysema(51.3%)were the most common complications of tracheobronchial foreign body. The type and the remaining time of foreign body were the independent risk factor for the formation of endotracheal granulation(P<0.01). The longer the disease duration,the greater the risk of granulation formation(P<0.01). The ROC curve showed that the remaining time of foreign bodies could be used as a reliable indicator of endotracheal granulation,critical values of the independent correlation factor was the course of disease more than 7.5 d. All the foreign bodies in 228 cases(100%)were successfully removed by fiberoptic bronchoscopy under local anesthesia,226 cases of 1-time take-out(success rate 99.1%),and no obvious complications occurred during and after surgery. CONCLUSION: Children aged from 1 to 3 years old are the high incidence of respiratory foreign body,and plants are more common. Plant foreign body residue is prone to endotracheal granulation,and the longer thecourse,the higher risk the granulation. Avoiding feeding infants nuts,early identification and correct diagnosis,and choosing the suitable operation method is the key to preventing and treating foreign body inhalation.
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Objective To put forward the prevention advice on foreign body suction,and to discuss the effica-cy,safety and application experience of flexible bronchoscopy in the diagnosis and treatment of tracheobronchial foreign bodies in children. Methods The treatment experience of 38 cases for airway foreign body removal with flexible bron-choscopy and granulation tissue proliferation in Argon plasma coagulation ( APC ) ( argon knife ) combining carbon dioxide( CO2 ) cryotherapy in Bayi Children′s Hospital Affiliated to General Hospital of Beijing Military Command from January 2013 to December 2014 were reviewed,and the clinical data including age,gender,treatment time for inhaled foreign body,clinical and X-ray manifestations,location of the foreign body,treatment with bronchoscopy with APC and cryotherapy,complications and outcomes were analyzed. Results There were 38 cases of patients including 31 male (81. 6%) and 7 female(18. 4%),aged from 10 months to 14 years old,with mean age 28. 5 months;among them there were 30 cases with definite history of foreign body,accounting for 78. 9%;the most common clinical symptom was cough among the cases,accounting for 84. 3%;X ray showed 15 cases with ipsilateral lung atelectasis,accounting for 39. 5%, emphysema in 17 cases,accounting for 44. 7%,pneumonia change in 6 cases,accounting for 15. 8%,there were 11 ca-ses who had lung computerized tomography examination when coming to the hospital,and only 1 case could be seen to have foreign body shadow;microscopic examination found that inhaled foreign body in the right bronchus accounted for 57. 9%,and peanut was the main foreign body inhalation in this group;only 4 cases(10. 5%) had definite diagnosis and foreign body removal within 24 h after foreign body aspiration,moreover,34 cases(89. 5%) with foreign body aspi-ration got the diagnosis and treatment after 24 h;crying was the primary inducement for inhaled foreign body. All the 38 cases of children with inhaled foreign body experienced removal under flexible bronchoscopy. There were 19 cases (50. 0%) who had granulation tissue proliferation around the foreign body,among which 5 cases of foreign body was wrapped by the proliferation of granulation tissue,with APC dealing with the granulation tissue of foreign body surface to remove foreign body after exposure,then giving CO2 cryotherapy. Nevertheless,there were 9 cases of foreign body who had granulation tissue but was not wrapped,receiving CO2 cryotherapy directly after the foreign body removal. One case of this group had bradycardia during the surgery,and 2 cases had postoperative bleeding,but there was no death cases with foreign bodies removal. Conclusions Education is the key to prevent foreign body aspiration in infants under 3 years old. Flexible bronchoscopy is safe to remove foreign bodies from the respiratory tract and has fewer complications, so it is one of the alternative methods in diagnosis and treatment of foreign body inhalation.
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Objective To evaluate the value of low dose multilayer spiral CT (MSCT) threedimensional reconstruction in diagnosis of children tracheobronchial foreign body.Methods Forty-three children with tracheobronchial foreign body which was confirmed by fiberoptic bronchoscopy were enrolled,and all of the children underwent low dose MSCT three-dimensional reconstruction.The volume data were reconstructed on work station (Siemens) with the techniques of multiple plane reformation (MPR),curved planar reconstruction (CPR),minimum intensity projection (MinIP),volume rendering (VR),CT virtual bronchoscopy (CTVB),and the results of MSCT were compared with fiberoptic bronchoscopy.Results The fiberoptic bronchoscopy results were used as the localization and qualitative diagnosis results.Locations of the foreign body were trachea and bifurcation of trachea (6 cases),right bronchus (23 cases) and left bronchus (14 cases),and the coincidence rate of localization diagnosis of MSCT was 100％ (43/43).Natures of the foreign body were nuts in 21 cases,beans in 5 cases,corn in 2 cases,fruits and vegetables in 6 cases,and other kinds in 4 cases.Qualitative diagnosis by MSCT was medium density foreign body,and the coincidence rate was 100％ (38/38).Five cases had bone mass,qualitative diagnosis by MSCT was high density bony foreign body,and the coincidence rate was 5/5.In 43 children,MPR (CPR) showed 41 cases (95.3％),CTVB showed 33 cases (76.7％),MinIP showed 34 cases (79.1％),VR showed 23 cases (53.5％),and axial scan showed 21 cases (48.8％).MPR (CPR) in showing foreign body rate was higher than other several postprocessing methods,and there were statistical differences (P ＜ 0.05).There was no statistical difference in the showing of foreign body between CTVB and MinIP (P ＞ 0.05),but CTVB and MinIP were higher than VR and axial scan,and there were statistical differences (P ＜ 0.05).Conclusions Low dose MSCT three-dimensional reconstruction is satisfactory in the diagnosis of children tracheobronchial foreign body.It can accurately evaluate the exact size,location,shape and pulmonary complications of foreign body,thus it plays an important role in the diagnosis of suspicious tracheobronchial foreign body.
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Objective To investigate the clinical effect of two different anaesthesia methods in removing the tracheobronchial foreign bodies in children.Methods This was a retrospective study with 56 hospitalized children through fiberoptic bronchoscope foreign body removing since September 2010 to July 2013 in Gansu Provincial Maternity and Child-Care Hospital.All of the children whose age from 8 months to 11 years were diagnosed of tracheal-bronchial foreign body.Among 56 cases,30 cases were operated with deep sedation anesthesia(deep sedation anesthesia group),and 26 cases with general anesthesia(general anesthesia group).The clinical effect of the two kinds of anesthesia were compared.Results The success rate of foreign bodies in deep sedation anesthesia group and general anesthesia group were 83.33％ and 96.15％ respectively (P ＞ 0.05),there were no statistical differences in oxygen desaturation (86.67 ％ vs 92.31％),cyanosis(30.00％ vs 26.92％),bleeding (16.67％ vs 15.38％),fever (6.67％ vs 3.85％),voice hoarse (40.00％ vs 34.62％),vomiting (26.67 ％ vs 19.23 ％),and other complications between two groups (P ＞ 0.05,respectively).There were significant differences in the rate of choking cough(11.54％ vs 93.33％) and resistance (0 vs 73.33％) between general anesthesia group and deep sedation anesthesia group (P ＜ 0.05).Compared with the deep sedation anesthesia group,the average hospitalization cost[(4 718.73 ± 1 012.61) (￥) vs (4 050.25 ± 1 176.75) (￥)] was bigger,and the average setup time [(18.54 ± 3.46) min vs (6.50-± 1.70) min] was longer,but the average removal of foreign body time [(13.32 ± 6.38) min vs (39.52 ± 15.68) min] was smaller in general anesthesia group,there were significant differences between two groups(P ＜ 0.05,respectively),while there was no statistical difference in the average hospitalization days [(5.46 ± 1.65) d vs (5.67 ± 1.65) d] between two groups (P ＞ 0.05).Conclusion Compared with the deep sedation anesthesia,the success rate of removal foreign bodies is higher,and the removal foreign body time as well as comfort are all significantly improved through general anesthesia,but the average hospitalization cost and average preparation time of general anesthesia are bigger than those of deep sedation anesthesia.
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In healthy adults, diagnosis of aspiration of foreign body into tracheobronchial tree is not difficult because various symptoms such as dyspnea, coughing, or cyanosis develop when foreign b~y is aspirated into tracheobronchial tree. But unless a clear history of an aspiration event can be obtained diagnosis will be delayed. Early complications of tracheobronchial foreign body aspiration include asphyxia, cardiac arrest, dyspnea, laryngeal edema, and cyanosis. Late complications include pneumonia, lung abscess, bronchiectasis, hemoptysis, bronchial stenosis, arid polyp. Treatment is removal of foreign body by operation or bronchoscopy. Currently, flexible bronchoscopy is preferred in adults than rigid bronchoscopy. A 36-year-old male visited to Dongkang hospital due to productive coughing and dyspnea On auscultation, focal inspiratory wheezing was heard. On chest PA, mild emphysematous change was seen. Flexible bronchoscopy was done. Bronchoscopically, mucoid impaction, surrounding inflammation, foreign body lodged in the right lower lobe bronchus, and interbronchial fistula(between right middle and lower lobe bronchus) were seen Foreign body(2.4 x 1.3cm sized antacid package) was removed by flexible bronchoscopy. Later, history of aspiration of a piece of antacid package was found. We report a case of recurrent bronchitis with interbronchial fistula as a result of occult aspiration of foreign body with review of the literatures.