Tracheobronchial Foreign Bodies in Children: Experience From 1,328 Patients in China

Abstract

Objective:To analyze the clinical characteristics of tracheobronchial foreign body (FB) cases in a pediatric Chinese population.MethodsThe clinical data of pediatric patients aged 0–18 years old diagnosed with a tracheobronchial FB in the Children's Hospital of Chongqing Medical University between September 2018 and August 2021 were analyzed retrospectively.ResultsAmong 1,328 included cases, 92.09% of patients were <3 years old, the male to female ratio was 1.86:1. The prevalence of tracheobronchial FB was similar between patients living in rural and urban areas and tracheobronchial FBs were more common in winter. The most common presenting symptoms were cough and wheezing. The most common CT findings was local obstruction or tracheobronchial narrowing, followed by obstructive emphysema of lung and pneumonia. The 11.3% of cases that did not report FB aspiration on admission had a longer time to hospital admission and longer hospitalization time than cases reporting FB aspiration (P < 0.05). The most common FB type was nuts (81.17%). FBs were more frequently located in the right bronchus, and 64 (4.82%) cases involved multiple FBs. FBs were expelled by coughing in only 4.07% of cases. For the other cases, FB removal by first bronchoscopy in our hospital was successful and complete in 96.86% of cases. 1.51% of patients had hypoxic ischemic encephalopathy (HIE) and the location of FBs was a possible risk factor for HIE (P < 0.05).ConclusionsTracheobronchial FBs occurred most commonly in children <3 years old. If asphyxia occurs in children which FBs aspirated, emergency treatment is needed to reduce the occurrence of HIE. Rigid bronchoscopy remains the first-line method for FB removal in children.

Preference matters: New aspects on how foreign bodies should and could be removed from a child's airway

“…At present, two endoscopic techniques are available for foreign body removal—rigid and flexible bronchoscopy—both offering various instruments to grab and remove the foreign body. Although there is a growing number of studies and case reports on foreign body removal that are performed by flexible bronchoscopy, professional societies still recommend the use of rigid bronchoscopy as the primary method of choice as it guarantees a secure airway 1,10–14 …”

“…Foreign body aspiration (FBA) remains a relevant concern in children between 6 months and 5 years of age. 1,2 Today, FBA remains a relevant cause of morbidity and mortality, especially in young children with narrow airways, who are at increased risk for significant airway obstruction. 2,3 The symptoms of FBA are manifold and unspecific, and particularly difficult to interpret when the aspiration event is unobserved.…”

“…Although there is a growing number of studies and case reports on foreign body removal that are performed by flexible bronchoscopy, professional societies still recommend the use of rigid bronchoscopy as the primary method of choice as it guarantees a secure airway. 1,[10][11][12][13][14] Nonetheless, endoscopic foreign body removal in children is not a standardized procedure, and bronchoscopists worldwide apply different protocols (e.g., anesthetic approach, order and type of the endoscopic procedure, instruments used in the working channel, composition of the endoscopic team, etc.). Objective decision criteria such as the position and nature of the foreign body or the clinical condition of the child can guide the bronchoscopist to choose the most appropriate technique.…”