A Time Series Observation of Chinese Children Undergoing Rigid Bronchoscopy for an Inhaled Foreign Body

Abstract

Background:In China, tracheobronchial foreign body (TFB) aspiration, a major cause of emergency episode and accident death in children, remains a challenge for anesthetic management. Here, we share our experience and discuss the anesthetic consideration and management of patients with TFB aspiration.Methods:This was a single-institution retrospective study in children with an inhaled foreign body between 1991 and 2010 that focused on the complications following rigid bronchoscopy (RB). Data including the clinical characteristics of patients and TFB, anesthetic method, and postoperative severe complications were analyzed by different periods.Results:During the 20-year study period, the charts of 3149 patients who underwent RB for suspected inhaled TFB were reviewed. There were 2079 male and 1070 female patients (1.94:1). A nut (84%) was the most commonly inhaled object. The study revealed a 9% (n = 284) overall rate of severe postoperative complications related to severe hypoxemia, laryngeal edema, complete laryngospasm, pneumothorax, total segmental atelectasis, and death with incidences of 3.2%, 0.9%, 1.3%, 0.3%, 0.3%, and 0.1%, respectively. The rates of preoperative airway impairment, negative findings of TFB, and adverse postoperative events have been on the rise in the past 5 years.Conclusions:The survey results confirmed that hypoxemia remains the most common postoperative complication in different periods. Both controlled ventilation and spontaneous ventilation were effective during the RB extraction of the foreign body at our hospital in the modern technique period. An active respiratory symptom was commonly seen in the groups with negative findings.

Morbidity and mortality in children undergoing bronchoscopy for foreign body removal

“…In Zhang et al's retrospective review of patients in their institution who had undergone rigid bronchoscopy for foreign body aspiration between 1991 and 2010, mortality rate was 0. 3%, whereas Boufersaoui et al had a mortality rate of 0.26% . These reports suggest that bronchoscopy is associated with a decreased mortality rate in AFBs when compared to all children with this diagnosis.…”

“…The percentage of patients with preoperative respiratory symptoms, complications, and negative bronchoscopies increased between 2005 and 2010. They felt that preoperative respiratory symptoms predicted postoperative complications . An Algerian study of children, most of whom had bronchoscopies for an AFB, spanning the years 1989 to 2012, showed a complication rate of 0.29% .…”

“…Prolonged hospital stay (>2 weeks) or ICU admission occurred in 33 patients (about 1%). 7 The percentage of patients with preoperative respiratory symptoms, complications, and negative bronchoscopies increased between 2005 and 2010. They felt that preoperative respiratory symptoms predicted postoperative complications.…”

“…They felt that preoperative respiratory symptoms predicted postoperative complications. 7 An Algerian study of children, most of whom had bronchoscopies for an AFB, spanning the years 1989 to 2012, showed a complication rate of 0.29%. 8 Foltran et al reported a pooled proportion for pneumonia related to an AFB to be 0.106, one of the most frequently encountered complications; pooled proportion for overall complications was 0.157.…”

Anaesthesia and peri-interventional morbidity of rigid bronchoscopy: A retrospective analysis

“…Pneumothorax is an uncommon complication of rigid bronchoscopy and previous studies with 3149 cases in the paediatric group showed an incidence of 0.3% [22]. Mechanical trauma to the tracheobronchial tree by the rigid bronchoscope as well as high peak inspiratory pressure during mechanical ventilation are likely causes of pneumothorax.…”