Extraction of Tracheobronchial Foreign Bodies in Children and Adults With Rigid and Flexible Bronchoscopy

Abstract

From our experience of extraction of TBFBs over more than a decade, we have drawn the following conclusions: (1) TBFBs present most frequently in the age group of 1 to 2 years, with cough and/or breathlessness commonly following a choking episode; (2) a high index of suspicion is essential and diagnostic FB should be performed in all such cases even though the chest radiograph is normal; (3) TBFBs can be life threatening and may require to be treated as an emergency; (4) FB may be used first for diagnosis and extraction under conscious sedation for nonasphyxiating TBFBs. It is usually more successful in adults and less so in children; (5) in these patients, if FB is unsuccessful, then RB may be used to extract the TBFB; (6) for asphyxiating TBFBs, RB is the procedure of choice; (7) pulmonologists who wish to practice extraction of TBFBs ought to be trained in both FB and RB and must possess adequate equipment and a skilled team to assist them.

Respiratory failure in adults due to foreign body aspiration: A case series

“…In most studies, a minority of patients (19-53%) present within one week of aspiration [4,6]. In 58-70% of the patients the delay in diagnosis was more than 1 month [1,6]. Much longer delays (1-40 years) after aspiration have been described [4][5][6].…”

“…Common findings on chest X-ray are atelectasis (2-50%), air trapping, emphysema (1-17%) or pneumonia (2-37%). Other, less common findings are pneumomediastinum, lung abscess, pleural effusion, lobar collapse and bronchiectasis [1,4,5].…”

“…Symptoms are usually nonspecific and are dependent on the nature of the FB, the diameter, location and eventually the development of complications. Symptoms that are commonly seen are cough (22-94%), dyspnea (6-35%), chest pain (2-22%), hemoptysis (11-24%), fever (8-31%) and wheezing (2-28%) rare are recurrent or chronic pneumonia, cardiac arrest or no symptom at all (2-9%) [1,2,4,6,7].…”

“…Ventilation strategy should be used with caution to prevent pressure associated lung injury. In acute asphyxiating FBA, rigid bronchoscopy, performed under general anesthesia, is the treatment of choice [1].…”

“…Foreign body aspiration (FBA) occurs frequently in children, but rarely in adults [1]. In different series where both children and adults with FBA were included, children represented 46-92% of the total study group [2,3].…”