Broncoscopia flexível como primeira opção para a remoção de corpo estranho das vias aéreas em adultos

Abstract

Objective: To determine the success rate of flexible bronchoscopy as the first-choice method of removing foreign bodies from the airways of adults. Methods: This was a retrospective study of all adult patients (over 18 years of age) with foreign body aspiration submitted to bronchoscopy between January of 2009 and January of 2011 at the University of São Paulo School of Medicine Hospital das Clínicas, located in São Paulo, Brazil. Results:The study sample comprised 40 adult patients, with a mean age of 52 years (range, 18-88 years). The median time of permanence of the foreign body in the airway was 15 days (range, 12 h to 10 years). All of the patients first underwent diagnostic flexible bronchoscopy. Foreign bodies were successfully removed with flexible bronchoscopy in 33 (82.5%) of the patients. In 1 patient, a metal object lodged in the distal bronchial tree required the use of fluoroscopy. Six patients (15%) required rigid bronchoscopy due to tracheal foreign bodyinduced dyspnea, in 2, and because the foreign body was too large for the flexible forceps, in 4. Bronchoscopy failed in 1 patient, who therefore required surgical bronchotomy. Conclusions: Although rigid bronchoscopy is considered the gold standard for the removal of foreign bodies from the airways, our experience showed that flexible bronchoscopy can be safely and effectively used in the diagnosis and treatment of stable adult patients.Keywords: Bronchoscopy; Foreign bodies; Airway obstruction; Airway management. ResumoObjetivo: Determinar a taxa de sucesso da broncoscopia flexível como primeira opção na remoção de corpos estranhos das vias aéreas em adultos. Métodos: Estudo retrospectivo de todos os pacientes adultos (acima de 18 anos) com aspiração de corpo estranho submetidos à broncoscopia no Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, em São Paulo (SP). Resultados: A amostra foi constituída por 40 pacientes adultos, com média de idade de 52 anos (variação: 18-88 anos). A mediana do tempo de permanência do corpo estranho na via aérea foi de 15 dias (variação: 12 h a 10 anos). Todos os pacientes foram submetidos primeiramente a broncoscopia flexível diagnóstica. A retirada do corpo estranho por meio de broncoscopia flexível foi bem-sucedida em 33 dos pacientes (82,5%). Em 1 paciente, um objeto metálico alojado na árvore brônquica distal requereu o uso de fluoroscopia. Seis pacientes (15%) foram submetidos à broncoscopia rígida devido a dispneia induzida por corpo estranho traqueal, em 2, e porque o corpo estranho era muito grande para as pinças flexíveis, em 4. A broncoscopia falhou em apenas 1 paciente, que portanto necessitou de broncotomia cirúrgica. Conclusões: Embora a broncoscopia rígida seja considerada o padrão ouro na remoção de corpos estranhos na via aérea, nossa experiência mostrou que a broncoscopia flexível pode ser utilizada segura e eficientemente no diagnóstico e tratamento de pacientes adultos estáveis.Descritores: Broncoscopia; Corpos estranhos; Obstrução das vias respiratórias; Manuse...

The simple bread tag – a menace to society?

“…Virtually all inhaled FBs can be extracted via bronchoscopy, with success rates of over 98%. [7] Rigid bronchoscopy is the standard technique for removal, but flexible bronchoscopy, often the technique used to remove an FB in an awake adult, is becoming increasingly used. In children it is generally used for the initial diagnostic procedure and thereafter may be used for the removal, depending on the individual circumstance and expertise.…”

“…Rigid bronchoscopes are advantageous in that they are bigger in diameter, allowing larger FB removal, aspiration of thick secretions and better patient ventilation. [7] Rigid endoscopes also have excellent optical visualisation and a wider array of ancillary instrumentation. [8] Generally, teams should be trained in both rigid and flexible bronchoscopy.…”

“…Some have suggested redesigning them to make them less hazardous, for example enlarging them, thereby minimising the chance of their being swallowed, [4] removing the sharp edges, or manufacturing them out of a radio-opaque material. [7] Others have called for complete cessation of their manufacture. [9][10][11] Bread tags are often made of brightly coloured plastic and are therefore attractive to young children.…”

Topics of pre-hospital care for schoolchildren: the perspective of professionals of the Mobile Emergency Care Service (SAMU)

“…19 Individuals with asphyxia caused by partial or total obstruction of the trachea and larynx mainly progress to death in few minutes. 20 The participants in the FG showed the importance of this topic making up the educational instrument: the following account shows the relevance of disseminating the first steps to be taken when faced with a situation of choking. In childhood, accidents involving aspirating foreign bodies mainly occur when children handle small toys and certain foods, mainly grains and seeds.…”

Missed distal tracheal foreign body in consecutive bronchoscopies in a 6-year-old boy

“…[4] Foreign bodies may be missed at bronchoscopy if covered by granulation tissue or multiple with the remaining ones not searched for. This article reports the case of a 6-year-old boy who had three sequential rigid bronchoscopies at three different hospitals which failed to identify the FB.…”