Airway Foreign Bodies: What's New?

Tracheobronchial foreign body (FB) aspiration is a common problem in children and adults. The medical history is the single most predictive factor in the clinical suspicion of FB aspiration. The “penetration syndrome” defined by the sudden onset of choking and coughing with or without vomiting should prompt concerns for FB aspiration. Findings on radiographic imaging include visualization of a radiopaque FB, atelectasis, postobstructive changes, mediastinal shift, and pneumomediastinum. In the presence of a high clinical suspicion even with normal imaging studies, bronchoscopy should be performed for a thorough evaluation of the airways.

Bronchoscopic extraction of airway FBs can be safely accomplished with both the rigid as well as the flexible bronchoscope in adults and children. Rigid bronchoscopy allows for control of the airway and provides excellent visualization with a variety of ancillary instruments available. Increasingly, both the adult and pediatric flexible bronchoscopes have been used successfully in the extraction of airway FBs utilizing urologic or bronchoscopic instruments. Airway control can be achieved with an endotracheal tube or a laryngeal mask airway. A delay in diagnosis increases morbidity including cough, wheeze, edema, and granulation tissue formation. Bronchoscopic evaluation and removal should be performed as soon as the diagnosis is suspected.

Airway - foreign body - bronchoscopy - flexible bronchoscope - rigid bronchoscope

REFERENCES

• 1 Vane D W, Pritchard J, Colville C W et al.. Bronchoscopy for aspirated foreign bodies in children.  Arch Surg. 1988;  123 885-888
• 2 Blumhagen J D, Wesenberg R L, Brooks J G et al.. Endotracheal foreign bodies.  Clin Pediatr (Phila). 1980;  19 430-434
• 3 Nonfatal choking-related episodes among children-United States, 2001.  MMWR Morb Mortal Wkly Rep. 2002;  51 945-948
• 4 Baharloo F, Veyckemans F, Francis C, Biettlot M P, Rodenstein D O. Tracheobronchial foreign bodies: presentation and management in children and adults.  Chest. 1999;  115 1357-1362
• 5 Swanson K L, Prakash U BS, Midthun D E et al.. Clinical characteristics in suspected tracheobronchial foreign body aspiration in children.  J Bronchol. 2002;  9 276-280
• 6 Oguzkaya F, Akcali Y, Kahraman C, Bilgin M, Sahin A. Tracheobronchial foreign body aspirations in childhood: a 10-year experience.  Eur J Cardiothorac Surg. 1998;  14 388-392
• 7 Brkic F, Delibegovic-Dedic S, Hajdarovic D. Bronchoscopic removal of foreign bodies from children in Bosnia and Herzegovina: experience with 230 patients.  Int J Pediatr Otorhinolaryngol. 2001;  60 193-196
• 8 Martinot A, Closset M, Marquette C H et al.. Indications for flexible versus rigid bronchoscopy in children with suspected foreign-body aspiration.  Am J Respir Crit Care Med. 1997;  155 1676-1679
• 9 Silva A B, Muntz H R, Clary R. Utility of conventional radiography in the diagnosis and management of pediatric airway foreign bodies.  Ann Otol Rhinol Laryngol. 1998;  107 834-838
• 10 Svedstrom E, Puhakka H, Kero P. How accurate is chest radiography in the diagnosis of tracheobronchial foreign bodies in children?.  Pediatr Radiol. 1989;  19 520-522
• 11 Zaytoun G M, Rouadi P W, Baki D H. Endoscopic management of foreign bodies in the tracheobronchial tree: predictive factors for complications.  Otolaryngol Head Neck Surg. 2000;  123 311-316
• 12 Swanson K L, Prakash U B, Midthun D E et al.. Flexible bronchoscopic management of airway foreign bodies in children.  Chest. 2002;  121 1695-1700
• 13 Limper A H, Prakash U B. Tracheobronchial foreign bodies in adults.  Ann Intern Med. 1990;  112 604-609
• 14 Swanson K L, Prakash U BS, McDougall J C et al.. Airway foreign bodies in adults.  J Bronchol. 2003;  10 107-111
• 15 Yazbeck-Karem V G, Aouad M T, Baraka A S. Laryngeal mask airway for ventilation during diagnostic and interventional fiberoptic bronchoscopy in children.  Paediatr Anaesth. 2003;  13 691-694
• 16 Mehta A C, Rafanan A L. “How I do it”: Extraction of airway foreign body in adults.  J Bronchol. 2001;  8 123-131
• 17 Roden S, Homasson J P. A new use for intrabronchial cryotherapy: extraction of foreign bodies.  Presse Med. 1989;  18 897
• 18 Umapathy N, Panesar J, Whitehead B F, Taylor J F. Removal of a foreign body from the bronchial tree: a new method.  J Laryngol Otol. 1999;  113 851-853
• 19 Bugmann P, Birraux J, Barrazzone C, Fior A, Le Coultre C. Severe bronchial synechia after removal of a long-standing bronchial foreign body: a case report to support control bronchoscopy.  J Pediatr Surg. 2003;  38 E14-E16
• 20 Skoulakis C E, Doxas P G, Papadakis C E et al.. Bronchoscopy for foreign body removal in children: a review and analysis of 210 cases.  Int J Pediatr Otorhinolaryngol. 2000;  53 143-148
• 21 Wroblewski I, Pin I. Outcomes of children after bronchial foreign body inhalation.  Ann Fr Anesth Reanim. 2003;  22 668-670
• 22 Castro M, Midthun D E, Edell E S, Stelck M J, Prakash U BS. Flexible bronchoscopic removal of foreign bodies from pediatric airways.  J Bronchol. 1994;  1 92-98