Removal of foreign bodies from the tracheobronchial tree

doi:10.1016/0022-3468(72)90484-8

Journal of Pediatric Surgery

Volume 7, Issue 2, April 1972, Pages 119-122

https://doi.org/10.1016/0022-3468(72)90484-8 Get rights and content

Abstract

With a 5-yr period, 82 infants and children were seen with confirmed foreign body aspiration. Seventy-five of them underwent bronchoscopy for removal of the foreign body. There was no correlation between duration of symptoms and hospitalization, and patients who had aspirated peanuts required no longer hospital stay than those who aspirated other vegetable or nonvegetable matter. Comparison of these results with a similar series treated primarily with postural drainage indicates that a 24-hr trial of this therapy will clear the airway in about 80% of children.

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There are more references available in the full text version of this article.

Cited by (37)

Forensic – Pathological SEM/EDX analysis in prosecution of medical malpractice
2019, Legal Medicine
Citation Excerpt :
Intracardiac collocation is considered exceptional [4,7]. Other reported finding spots are: the nose [8], tracheo-bronchial tree [9], breasts [10], femur [11] and vertebral column [12]. The use of the SEM/EDX analysis (Scanning Electron Microscopy with Energy Dispersive X-ray spectroscopy) finds in the forensic field several recent applications.
The retention of gauze within the mediastinum is considered an exceptional finding. We are presenting the case of a woman, affected by aorto-mitral valvulopathy, in whose mediastinum was found, during the autopsy, a gauzome without signs of active phlogosis, which had been “forgotten” in a previous surgery, acted 14 years before the death.
A 39 y.o. woman had received surgical treatment of double aorto-mitral valve substitution and tricuspid plastic. At age 53, she successfully received surgery once again at a different hospital; she then started rehabilitation therapy, during which she deceased due to sudden hematemesis with infectious multi organ failure. During the autopsy, a 5 cm long surgical gauze was found in the mediastinum. A SEM/EDX (Scanning Electron Microscopy with Energy Dispersive X-ray spectroscopy) exam was ran on the foreign body and a sample of the same gauze used in the cardiac-surgical department of the hospital the victim had passed away in, to act a comparison between the two kinds of material. The exam showed a morphological difference between exogenous fibers incorporated within the gauzome and the control gauze.
This case highlights the diagnostic and interpretative challenges in finding a foreign body within the mediastinum without signs of active phlogosis. SEM/EDX investigations executed on the gauzome and a “control gauze” allowed the attribution of malpractice to the first hospital the victim had been operated in 14 years before the exitus. The SEM/EDX exam confirms its importance in correctly identifying the case, which becomes an example for similar happenings.
The utility of adding expiratory or decubitus chest radiographs to the radiographic evaluation of suspected pediatric airway foreign bodies
2013, Annals of Emergency Medicine
Citation Excerpt :
Because they may be helpful in supporting the diagnosis and may alter the timing of or approach to bronchoscopy, most otolaryngologists still recommend them.15-17 Special radiographic views (assisted expiratory or bilateral decubitus) have been recommended to assist in the diagnosis of air trapping, which may provide indirect evidence of a respiratory foreign body not otherwise apparent on standard (frontal and lateral) chest radiographs.18-23 These special views aim to provide a radiograph wherein a normal lung appears less inflated, and the hyperinflation caused by an airway foreign body is more identifiable.
This study aimed to compare test characteristics of standard (lateral and posteroanterior or anteroposterior) chest radiographs with and without special views (expiratory or bilateral decubitus) in the emergency department evaluation of children with suspected airway foreign bodies.
From 1997 to 2008, 328 patients with a suspected airway foreign body had standard and special view chest radiographs: 192 with left and right decubitus views, 133 with expiratory views, and 3 with both. Patients were excluded for cardiorespiratory disease, chest wall deformity, visible airway foreign bodies on standard views, or spontaneously expelled airway foreign bodies. After blinded radiologist review, standard plus special view test characteristics were compared to standard views.
Nine upper airway and 70 tracheobronchial airway foreign bodies were identified by direct visualization or bronchoscopy, and the remainder were ruled out by bronchoscopy (50 patients) or clinically (199 patients). The sensitivity and specificity of the radiographs were, respectively, decubitus cohort, standard views, 56% and 79% and standard+decubitus views, 56% and 64%; expiratory radiograph cohort, standard views, 33% and 70% and standard+expiratory views, 62% and 72%. For standard plus decubitus views versus standard views alone, the relative sensitivity was 1.0 (0.56/0.56; 95% confidence interval [CI] 0.81 to 1.23) and the relative 1–specificity was 1.76 (0.36/0.21; 95% CI 1.3 to 2.37). For standard plus expiratory views versus standard views alone, the relative sensitivity was 1.87 (0.62/0.33; 95% CI 1.23 to 2.83) and the relative 1–specificity was 0.93 (0.28/0.3; 95% CI 0.6 to 1.44).
The addition of decubitus to standard views increases false positives without increasing true positives and lacks clinical benefit. The addition of expiratory to standard views increases true positives without increasing false positives, but test accuracy remains low and the clinical benefit is uncertain.
Foreign Body Aspiration
2008, Pediatric Respiratory Medicine
Foreign Body Aspiration
2006, Kendig's Disorders of the Respiratory Tract in Children
Foreign Bodies in the Pediatric Patient
1998, Current Problems in Surgery
Management of tracheobronchial and esophageal foreign bodies in children: A survey study
1994, Journal of Clinical Anesthesia
Study Objective: To assess the current anesthetic management for aspiration of a foreign body into the airway and esophagus of a young child.
Design: Questionnaire study.
Measurements and Main Results: A questionnaire regarding choice of induction technique in a variety of foreign body clinical scenarios was sent to 1,342 anesthesiologists, all members of the Society for Pediatric Anesthesia. The foreign body, either a coin (penny) or a safety pin (open), was positioned on radiography in a variety of anatomic locations. Depending on the foreign body location, the patient was either asymptomatic or exhibited symptoms. Participants indicated their choice of induction for each situation. Of the 1,342 questionnaires mailed, there were 838 respondents (62.4%). Coins and pins in the gastroesophageal tract were managed mostly by a rapid-sequence induction (p < 0.001). Coins and pins at all levels in the tracheobronchial tree were managed most often by a mask induction with no cricoid pressure (p < 0.001). Although 14.5% of respondents chose awake and sedated technique for a foreign body in the supraglottic area, few chose this technique for a foreign body in other locations. The type of object did not affect the choice of drugs for induction of anesthesia in most anatomic locations. Respondents with limited pediatric anesthesia experience used inhalation induction much less often than did those with more experience. Multiple-logistic regression analysis showed that both number of years in practice and type of practice (university, private, hybrid) were predictors for the induction.
Conclusions: These data indicate that inhalation induction is favored most often for removal of foreign bodies in the airway, while intravenous induction is preferred for removal of foreign bodies in the gastroesophageal tract. In addition, practice type, greater percentage of time spent in pediatric anesthesia, and greater experience are related to a higher likelihood of inhalation induction.

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^☆: Presented before the Surgical Section of the American Academy of Pediatrics, Chicago, Ill., October 16–17, 1971.

¹: Surgeon-in-Chief, The Children's Hospital; Associate Professor of Surgery, Division of Pediatric Surgery, University of Colorado Medical Center, Denver, Colo.

²: Associate Professor of the Department of Pediatrics, University of Colorado Medical Center, Denver, Colo.

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Removal of foreign bodies from the tracheobronchial tree☆

Abstract

Ann. Thorac. Surg.

Dis. Chest

Ann. Thorac. Surg.

Ann. Thorac. Surg.

Airway foreign body fatalities in children

Ann. Otol.