The multivariate analysis of indications of rigid bronchoscopy in suspected foreign body aspiration

Divarcı, Emre; B, Toker; Dökümcü, Zafer; Musayev, A.; Özcan, Coşkun

doi:10.1016/j.ijporl.2017.07.012

Cited by 23 publications

(15 citation statements)

References 19 publications

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“…Rigid bronchoscope is mostly used for the removal of solid FBs. Undiagnosed and retained FBs may lead to serious complications such as pneumonia, lung abscess, and bronchiectasis 2,3. Rigid bronchoscopies is safely performed under general anesthesia in an operating room environment.…”

Section: Introductionmentioning

confidence: 99%

Management of anesthesia and complications in children with Tracheobronchial Foreign Body Aspiration

Karaaslan

Yıldız²

2019

Pak J Med Sci

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Objectives:Delayed diagnosis and treatment of tracheobronchial foreign body aspiration (FBA) in children may lead to morbidity and mortality. Our objective was to evaluate the anesthetic management, peri- and post-operative complications, and predisposing factors for postoperative intensive care unit (ICU) admission in children undergoing rigid bronchoscopy due to tracheobronchial FBA.Methods:This retrospective study included 81 children who underwent rigid bronchoscopy between January 2010 to July 2018 at Inonu University, Department of Pediatric Surgery, Turkey. Data regarding demographic characteristics, anesthetic management, length of ICU and hospital stays, and peri- and post-operative complications were retrieved from the hospital database.Results:The patients included 54 (66.7%) boys and 27 (33.3%) girls with a mean age of 29.6 ± 31.2 months. The most common presenting symptom was the suspicion of FBA, followed by acute-onset cough, cyanosis, wheezing and respiratory distress. Mean duration of anesthesia was 44.40 ± 14.72 min. Of the 81 patients, 18 (22.2%) were transferred to ICU and 63 (77.8%) patients were transferred to the ward postoperatively. Of the patients transferred to the ICU, 5 of them required mechanical ventilation. Some peri and postoperative complications, desaturation (n=16; 19.7%; p=0.001), mucosal bleeding (n=6; 7.4%; p=0.02), laryngeal edema (n=11; 13.6%; p<0.001), laryngospasm (n=13; 16.3%; p<0.001), were affected the frequency of intensive care transfer.Conclusion:Bronchoscopy with general anesthesia remains the golden standard for the management of tracheobronchial FBA. In such patients, a combination consisting of a detailed preoperative clinical evaluation of the patient, selection of short-acting anesthetic agents with minimal side effects for the induction and maintenance of anesthesia, and the administration of controlled ventilation can be recommended. Additionally, early diagnosis of peri- and post-operative complications, prediction of postoperative ICU requirement, and a close cooperation of anesthesiologists and surgeons are highly important.

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Section: Introductionmentioning

confidence: 99%

Management of anesthesia and complications in children with Tracheobronchial Foreign Body Aspiration

Karaaslan

Yıldız²

2019

Pak J Med Sci

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“…Likewise, our findings are consistent with Sink et al 40 who reported that chest wheezes combined with decreased breath sounds had increased odds of FBA. Additionally, Divarci et al 41 concluded that the presence of a positive history as well as clinical and radiologic findings together showed high sensitivity (91%) in predicting FBA. An earlier prospective study highlighted the presence of a radiopaque FB, and associated unilaterally decreased breath sounds and obstructive emphysema as statistically significant predictors of FBA.…”

Section: Discussionmentioning

confidence: 99%

Foreign Body Aspiration in Egyptian Children Clinical, Radiological and Bronchoscopic Findings

Reyad¹,

El-Deeb²,

Abbas³

et al. 2021

JMDH

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Purpose: Foreign body aspiration (FBA) is a frequent cause of childhood morbidity and mortality. Diagnosis of FBA is challenging in the absence of a witnessed aspiration event. The aim of this study was to determine the accuracy of presenting symptoms as well as physical and radiologic findings as predictors of FBA in children. Thus, indications for bronchoscopy could be determined in such cases. Methods: This retrospective cohort study was conducted in the ENT department, Kafrelsheikh University Hospital. The medical records of patients younger than 16 years old who underwent rigid bronchoscopy for suspected FBA were included. Data including age, gender, symptoms, physical examination findings, radiological features, nature and location of foreign body, and outcome of the bronchoscopy were collected. Results: This study included 130 patients, 105 (80.8%) patients were positive for the presence of a foreign body in their airways. Foreign bodies were most frequently (43.8%) lodged in the right main bronchus, and nuts (66.7%), were the most commonly retrieved. Multivariate regression analysis identified the presence of suggestive signs or symptoms as independent predictors of FBA on rigid bronchoscopy. Conclusion:Objective finding of clinical signs eg unilateral wheezes on chest examination in the presence of symptoms such as a sudden cough, dyspnea, and hoarseness could predict FBA and help physicians in deciding bronchoscopy.

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“…Limitations of this study include relatively small sample size, which may have resulted in a type II error in attempting to identify predictors of positive RB in the setting of suspected TBFA. Similar studies had shown conflicting results, with Heyer et al concluding that witnessed aspiration, hyperinflation on CXR and white cell count to be statistically significant predictors of positive RB (12) while Divarci et al had found that all positive clinical, examination and radiological findings were statistically significant predictors (26). Therefore, larger studies may be required to further assess clinico-radiological predictors of positive RB.…”

Section: Discussionmentioning

confidence: 99%

Clinico-radiological predictors of positive rigid bronchoscopy findings in children with suspected tracheobronchial foreign body aspiration

et al. 2018

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Background: Tracheobronchial foreign body aspiration (TFBA) is common in young children and is associated with potentially significant morbidity, and sometimes mortality. Although rigid bronchoscopy (RB) is often needed for definitive diagnosis, it can be associated with intra-operative and long-term risks. Methods: Hospital records of patients under 18 years of age who underwent RB for suspected TFBA between November 2010 and May 2016 were retrospectively reviewed. Data extracted include age, gender and date of TFBA. Specific pre-operative clinical and radiological findings were compared with findings at RB. Results: Of 43 children admitted with suspected TFBA, 72% were aged under 3 years. 79.1% had a FB identified at RB. Clinical history of inhalation, auscultation and radiographic abnormalities [hyperinflation, collapse, suspected foreign body (FB)] were not significantly different for children with, compared to those without, TFBA at RB. Conclusions: Although RB remains the definitive management for suspected TFBA, the potential risks and non-specific clinical and radiological findings mean other imaging techniques such as low dose multidetector computed tomography (MDCT) should be explored.

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The multivariate analysis of indications of rigid bronchoscopy in suspected foreign body aspiration

Cited by 23 publications

References 19 publications

Management of anesthesia and complications in children with Tracheobronchial Foreign Body Aspiration

Management of anesthesia and complications in children with Tracheobronchial Foreign Body Aspiration

Foreign Body Aspiration in Egyptian Children Clinical, Radiological and Bronchoscopic Findings

Clinico-radiological predictors of positive rigid bronchoscopy findings in children with suspected tracheobronchial foreign body aspiration

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