1
|
Louhaichi S, Boubaker N, Hamdi B, Nemsi E, Ouerghi S, Mestiri T, Marghli A, Ammar J, Hamzaoui A. Removal of airway foreign body using flexible bronchoscopy in children. Arch Pediatr 2024:S0929-693X(24)00054-X. [PMID: 38637247 DOI: 10.1016/j.arcped.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/11/2023] [Accepted: 01/21/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Flexible bronchoscopy is mainly used to diagnose airway foreign bodies (AFBs). Due to advances in pediatric anesthesia, many teams have considered the extraction of AFBs by flexible bronchoscopy. We aimed to assess the success of flexible bronchoscopy in AFB removal in children. PATIENTS AND METHODS We analyzed retrospectively the data of children admitted for AFB aspiration in the Pediatric Respiratory Diseases Department B of Abderrahmane Mami Hospital in Tunisia between January 2012 and December 2022. AFB removal was performed by flexible bronchoscopy through the use of a laryngeal mask airway (LMA) or intubation. RESULTS Of the 105 children included, AFB was removed by flexible bronchoscopy in 99 children (94.3 %). The mean age of the children was 32 months (9-150 months) with a sex ratio of 2:3. The foreign body was organic in 67 % of cases. Overall, 37 children underwent rigid bronchoscopy first (35.2 %). Flexible bronchoscopy was performed through the LMA in 77 cases (73 %) and after intubation in the other cases. Thoracic surgery was needed in two cases (1.9 %). Four infants expectorated the AFB after the procedure (3.8 %). Only two children developed laryngeal edema with transient oxygen desaturation. CONCLUSION AFB removal using a flexible bronchoscope is an efficient and safe procedure when performed by an experienced team. The recent use of LMA has facilitated the use of a larger bronchofiberscope and the insertion of multiple tools that can reach distal airways.
Collapse
Affiliation(s)
- Sabrine Louhaichi
- Department of Pulmonology, B. Abderrahmen Mami Hospital, Ariana, Tunisia
| | - Nouha Boubaker
- Department of Pulmonology, B. Abderrahmen Mami Hospital, Ariana, Tunisia.
| | - Besma Hamdi
- Department of Pulmonology, B. Abderrahmen Mami Hospital, Ariana, Tunisia
| | - Ella Nemsi
- Department of Pulmonology, B. Abderrahmen Mami Hospital, Ariana, Tunisia
| | - Sonia Ouerghi
- Anesthesiology Department, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Taher Mestiri
- Anesthesiology Department, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Adel Marghli
- Department of Thoracic Surgery, Abderrahmane Mami Hospital, Ariana, Tunisia
| | - Jamel Ammar
- Department of Pulmonology, B. Abderrahmen Mami Hospital, Ariana, Tunisia
| | - Agnès Hamzaoui
- Department of Pulmonology, B. Abderrahmen Mami Hospital, Ariana, Tunisia
| |
Collapse
|
2
|
Pozailov S, Goldbart A, Aviram M, Maimon MS, Dizitzer Hillel Y, Gatt D, Raviv I, Avraham S, Kaplan O, Tsaregorodtsev S, Golan-Tripto I. Foreign body aspiration score (FOBAS)-a prospectively validated algorithm for the management and prediction of foreign body aspiration in children. Eur J Pediatr 2024; 183:815-825. [PMID: 38017338 DOI: 10.1007/s00431-023-05347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
Foreign body aspiration (FBA) is a common cause of pediatric morbidity, but a standardized protocol to guide decision-making about bronchoscopy is lacking. We aimed to validate a new Foreign body aspiration score (FOBAS) for the pediatric emergency department (ED). Patients aged 0-18 years referred to the ED for suspected FBA were prospectively enrolled. FOBAS was calculated according to clinical features of a choking episode, sudden cough, exposure to nuts, absence of fever and rhinitis, stridor, and unilateral auscultatory and radiological findings. FBA risk was evaluated based on the total score (low, 1-3; moderate, 4-6; high, 7-10). Low-risk children were discharged from the ED and followed clinically. Moderate-risk children were hospitalized and evaluated by a pediatric pulmonologist, and high-risk children were referred directly for therapeutic bronchoscopy. Among the 100 enrolled children (59% males; median age 20 [interquartile range 11-39] months), a foreign body was diagnosed in 1/49 (2%), 14/41 (34.1%), and 9/10 (90%) with low, moderate, and high FOBAS, respectively (P < .001). Logistic regression indicated a higher risk for FBA with higher scores. The odds ratio for each additional point was 2.75 (95% confidence interval 1.78-4.24), and FOBAS showed a high predictive value for FBA (area under the curve 0.89). FOBAS implementation significantly reduced the rate of negative bronchoscopies, from 67.4% annually during 2016-2019 to 50% in 2020 (P = .042). CONCLUSION FOBAS reliably predicts FBA in cases of suspected FBA and improves management and in-hospital decision-making. WHAT IS KNOWN • Foreign body aspiration is a major cause of pediatric morbidity and mortality. • Currently, there is no unified protocol for children referred to the emergency department for suspected FBA, therefore, a well-defined algorithm is needed to improve the decision-making process. WHAT IS NEW • The pediatric Foreign body aspiration score (FOBAS) is a new, prospectively validated clinical score that shows high sensitivity and specificity for the presence of FBA in children. • FOBAS reduces unnecessary admissions and invasive procedures and leads to better clinical outcomes.
Collapse
Affiliation(s)
- Shani Pozailov
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviv Goldbart
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Micha Aviram
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Michal S Maimon
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatric Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yotam Dizitzer Hillel
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Dvir Gatt
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Inbal Raviv
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shir Avraham
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Or Kaplan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatric Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergey Tsaregorodtsev
- Department of Anesthesiology and Intensive Care, Soroka University Medical Center, Beer-Sheva, Israel
| | - Inbal Golan-Tripto
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.
| |
Collapse
|
3
|
Raviv I, Pozailov S, Avraham S, Aviram M, Goldbart A, Dizitzer Y, Gatt D, Tsaregorodtsev S, Golan-Tripto I. Evaluation of Foreign body aspiration score (FOBAS) in children- A retrospective cohort study. Eur J Pediatr 2023; 182:4205-4212. [PMID: 37450025 DOI: 10.1007/s00431-023-05095-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
Foreign Body Aspiration (FBA) is a common medical emergency among young children, but the evaluation and management of a suspected FBA case can vary across physicians and centers. We aimed to identify which clinical, laboratory, and radiological findings can predict FBA in children and to evaluate a clinical score to improve FBA prediction. This is a retrospective cohort study of patients aged 0-18 years admitted to Soroka University Medical Center between 2010 and 2020 with suspected FBA. All patients underwent flexible bronchoscopy and were divided into positive and negative FBA groups. A newly developed foreign body aspiration score (FOBAS), based on medical history, physical examination, and chest X-ray findings, was evaluated for its predictability. The study included 412 children (median age 21 months, 56.8% females), of whom 154 (37.4%) had FBA and 258 (62.6%) did not. Multivariate regression analysis showed exposure to nuts/seeds, unilateral wheezing or decreased breath sounds, stridor, and suggestive findings on chest X-ray were significant risk factors for FBA (OR [95%CI] -1.994[1.290-3.082], 1.487[1.206-1.832], 1.883 [1.011-3.509] and 2.386[1.917-2.970], respectively). However, a choking episode, acute cough, and absence of fever and rhinorrhea did not predict FBA. FOBAS showed an increased risk of FBA for each additional point of the score, with an odds ratio of 1.572 (95% CI-1.389-1.799). Conclusion: FOBAS is a good predictor for the presence of FBA in children. Once prospectively validated, FOBAS could aid in decision-making at the emergency department, enabling more standardized care, reducing unnecessary procedures, and leading to better clinical outcomes. What is Known: • The evaluation and management of a child with suspected foreign body aspiration (FBA) vary across physicians and centers, without a consensus regarding the indications and criteria for performing bronchoscopy. • Flexible bronchoscopy is the standard procedure for the diagnosis and sometimes treatment of FBA in children, but it may hold potential complications. What is New: • We propose a newly developed foreign body aspiration score (FOBAS), based on medical history, physical examination, and chest X-ray findings, for the prediction of FBA in children at the emergency department. • The FOBAS is a good predictor of FBA in children. The score enables more standardized care and may reduce unnecessary procedures.
Collapse
Affiliation(s)
- Inbal Raviv
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shani Pozailov
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatrics, Soroka University Center Beer-Sheva, Beer-Sheva, Israel
| | - Shir Avraham
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Micha Aviram
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Aviv Goldbart
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatrics, Soroka University Center Beer-Sheva, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yotam Dizitzer
- Department of Pediatric C, Schneider Children's Medical Center of Israel, Petach Tikvah, Beer-Sheva, Israel
| | - Dvir Gatt
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatrics, Soroka University Center Beer-Sheva, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergey Tsaregorodtsev
- Department of Anesthesiology and Intensive Care, Soroka University Medical Center, Beer-Sheva, Israel
| | - Inbal Golan-Tripto
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Department of Pediatrics, Soroka University Center Beer-Sheva, Beer-Sheva, Israel.
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.
| |
Collapse
|
4
|
Zakynthinos GE, Mpaggeas A, Deskata K, Doudakmanis C, Makris D. Flexible Bronchoscopy Combined With an Airway Maneuver for Foreign Material Removal Under Invasive Mechanical Ventilation. Cureus 2023; 15:e44239. [PMID: 37772228 PMCID: PMC10523186 DOI: 10.7759/cureus.44239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
We present a case of a patient who had aspirated a massive amount of food, leading to cardiac arrest, and had to be intubated because of severe hypoxemia. The hypoxemia persisted, regardless of the recruitment maneuvers, performance of flexible bronchoscopy, and suctioning through the ventilating tube, because we were unable to reach the left main bronchus (LMB), where the greatest amount was concentrated. However, we managed to overcome this problem by using a prototype handling technique to catheterize the LMB directly with the usage of the flexible bronchoscope. We introduce this handling technique for the removal of foreign material from the LMB, which will probably be really useful in emergency situations, because of its simplicity and effectiveness.
Collapse
Affiliation(s)
| | | | - Konstantina Deskata
- Department of Critical Care, University General Hospital of Larissa, Larissa, GRC
| | | | - Demosthenes Makris
- Department of Critical Care, General University Hospital of Larissa, Larissa, GRC
| |
Collapse
|
5
|
Keil O, Schwerk N. Foreign body aspiration in children - being safe and flexible. Curr Opin Anaesthesiol 2023; 36:334-339. [PMID: 36745076 DOI: 10.1097/aco.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Anesthesia for foreign body removal in children can be quite challenging. Even though rigid bronchoscopy is considered the gold standard for foreign body removal, there is increasing evidence for successful foreign body removal using flexible bronchoscopy. This review discusses the recent implications for flexible bronchoscopy for the purpose of foreign body removal and will compare these findings to rigid bronchoscopy. RECENT FINDINGS During the last few years, several observational studies on foreign body removal by flexible bronchoscopy have been published, with promising results. SUMMARY Flexible bronchoscopy is a feasible and safe method for removing aspirated foreign bodies in children. In order to improve patient safety during the procedure, it is necessary for a pediatric anesthetist and a pediatric pulmonologist to work closely together. The anesthetist can take care of the administration of the anesthetic and maintenance of the vital functions, and the pulmonologist can carry out a safe and fast bronchoscopy. In the case of foreign body removal by flexible bronchoscopy, the anesthesiological procedure of choice should be general anesthesia with controlled ventilation via a laryngeal mask.
Collapse
Affiliation(s)
- Oliver Keil
- Clinic of Anesthesiology and Intensive Care Medicine
| | - Nicolaus Schwerk
- Clinic of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School
- BREATH (Biomedical Research in End-stage and obstructive Lung Disease Hannover), German Center for Lung Research (DZL), Hannover, Germany
| |
Collapse
|
6
|
Shir A, Micha A, Novik FE, Elizabeth HS, Shani P, Maija L, Inbal R, Aviv G, Yotam D, Inbal GT. Comparison of chest X-ray interpretation by pediatric pulmonologists, pediatric radiologists, and pediatric residents in children with suspected foreign body aspiration-a retrospective cohort study. Eur J Pediatr 2023:10.1007/s00431-023-04943-z. [PMID: 37081195 DOI: 10.1007/s00431-023-04943-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 04/22/2023]
Abstract
Chest X-ray (CXR) is an important tool in the assessment of children with suspected foreign body aspiration (FBA), although it can falsely be interpreted as normal in one-third of the cases. The aim of this study is to evaluate the positive predictive value of CXR in children hospitalized with suspected FBA, when interpreted by three disciplines: pediatric pulmonology, pediatric radiology, and pediatric residents. This is a retrospective study that included children aged 0-18 years, admitted with suspected FBA, between 2009 and 2020 in one tertiary center. All patients underwent CXR and a flexible/rigid bronchoscopy for the definitive diagnosis of FBA, up to 1 week apart. Two physicians from each discipline interpreted the CXR, independently. Intra-raters' and inter-raters' agreements were assessed. Sensitivity, specificity, and area under the curve (AUC) were calculated for each discipline. Four hundred seventy-three children were included in the study, 175 (37%) with FBA and 298 (63%) without FBA on flexible/rigid bronchoscopy. The most common radiological findings, as interpreted by a pediatric pulmonologist, were unilateral hyperinflation (47%), radiopaque FB (37.6%), lobar atelectasis (10.3%), unilateral hyperinflation with atelectasis (3.4%), and lobar consolidation (1.7%). Intra-raters' agreement ranged from 0.744 (p < 0.001) among pediatric pulmonologists to 0.326 (p < 0.001) among pediatric radiologists. AUC for predicting FBA based on a CXR was 0.81, 0.77, and 0.7 when interpreted by pediatric pulmonologists, pediatric residents, and radiologists, respectively (p < 0.001). CONCLUSIONS CXR has a high positive predictive value and independently predicts FBA in children; however, normal CXR should not rule out FBA. Predictability is variable among different disciplines. WHAT IS KNOWN • Chest X-ray is an important tool in the assessment of children with suspected foreign body aspiration (FBA). • Chest X-ray can be interpreted as normal in one-third of the cases. WHAT IS NEW • Chest X-ray independently predicts FBA in children, with a high positive predictive value. • The ability of chest x-ray to predict FBA in children differs between pediatric residents, pediatric radiologists, and pediatric pulmonologists.
Collapse
Affiliation(s)
- Avraham Shir
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviram Micha
- Pediatric Pulmonary Unit, Soroka University Medical Center, Yitzhak Rager Ave, PO Box 151, Beer-Sheva, 8410101, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Hoch Sarah Elizabeth
- Department of Radiology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Pozailov Shani
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Levin Maija
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
| | - Raviv Inbal
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Goldbart Aviv
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Yitzhak Rager Ave, PO Box 151, Beer-Sheva, 8410101, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dizitzer Yotam
- Departmant of Pediatrics, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Golan-Tripto Inbal
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.
- Pediatric Pulmonary Unit, Soroka University Medical Center, Yitzhak Rager Ave, PO Box 151, Beer-Sheva, 8410101, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| |
Collapse
|
7
|
Wiemers A, Vossen C, Lücke T, Freitag N, Nguyen TMTL, Möllenberg L, Pohunek P, Schramm D. Complication rates in rigid vs. flexible endoscopic foreign body removal in children. Int J Pediatr Otorhinolaryngol 2023; 166:111474. [PMID: 36753891 DOI: 10.1016/j.ijporl.2023.111474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
While foreign body aspiration remains a frequent and preventable cause of morbidity and mortality in children, recommendations on the appropriate removal technique do often not match the lived practice and expertise of the performing examiners. As there is a scarcity of data regarding success and complication rates of the procedure, the aim of this study was to set up a classification system for procedure-related complications, prospectively record and analyze them. Specialists in the field of foreign body removal contributed cases anonymously. Information regarding procedural details of the bronchoscopy, type, and severity of complications as well as patient characteristics were classified and recorded. Correlations were calculated using Pearson's Chi Square test. A total of 314 rigid and 178 flexible bronchoscopies were compared. Complications were categorized and their severity was defined by the anesthesiologist's assessment of whether to interrupt or terminate the procedure. The overall complication rate was similar in rigid vs. flexible bronchoscopy (19.1% vs. 24.2%, p = 0.232), while respiratory complications occurred significantly less frequent during rigid bronchoscopy (9.2% vs. 16.3%, p = 0.025). This is the largest pediatric case collection recording and comparing complications between rigid and flexible foreign body removal. The higher rate of respiratory complications in flexible bronchoscopy has been shown for the first time and validates some of the concerns about its use for foreign body removal. Flexible bronchoscopy is a safe procedure when extended respiratory monitoring and the possibility of an immediate switch to a secured airway are assured.
Collapse
Affiliation(s)
- Anna Wiemers
- Ruhr University Bochum, Children's Hospital St. Josef-Hospital, Bochum, Germany.
| | - Christina Vossen
- Städtische Kliniken Mönchengladbach, Elisabeth Krankenhaus, Rheydt, Germany
| | - Thomas Lücke
- Ruhr University Bochum, Children's Hospital St. Josef-Hospital, Bochum, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Thi Minh Thao Lea Nguyen
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Leon Möllenberg
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Petr Pohunek
- Pediatric Department, Charles University Prague and University Hospital Motol, Prague, Czech Republic
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
8
|
Golan-Tripto I, Tsabari R, Picard E, Stafler P, Armoni Domany K, Goldbart AD, Aviram M, Gatt D, Bari R, Tsaregorodtsev S, Peled C, Melnik P, Bar-Yoseph R, Gut G. Foreign body aspiration in Israeli children during the COVID-19 pandemic. Pediatr Pulmonol 2023; 58:425-432. [PMID: 36224102 DOI: 10.1002/ppul.26203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/29/2022] [Accepted: 10/08/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, there has been a decline in pediatric emergency department visits. Our aim was to assess the pattern of pediatric foreign body aspiration (FBA) during the first year of the COVID-19 pandemic, in comparison to the prior years. METHODS In this retrospective multicenter study, we compared the number of children who presented with FBA during the COVID-19 year (March 1, 2020 to February 28, 2021) to the annual average of the years 2016-2019. We also compared the lockdown periods to the postlockdown periods, and the percentage of missed FBA, proven FBA, and flexible bronchoscopy as the removal procedure. RESULTS A total of 345 children with FBA from six centers were included, 276 in the pre-COVID-19 years (average 69 per year) and 69 in the COVID-19 year. There was no difference in the prevalence of FBA between the COVID-19 year and any of the prior 4 years. Examining the lockdown effect, the monthly incidence of FBA dropped from a pre-COVID-19 average of 5.75 cases to 5.1 cases during lockdown periods and increased to 6.3 cases in postlockdown periods. No difference in the percentage of missed FB or proven FB was observed. There was a significant rise in the usage of flexible bronchoscopy as the removal procedure (average of 15.4% vs. 30.4%, p = 0.001). CONCLUSION There were fewer cases of pediatric FBA during lockdown periods, compared to post-lockdown periods, presumably related to better parental supervision, with no difference in the prevalence of FBA during the COVID-19 year.
Collapse
Affiliation(s)
- Inbal Golan-Tripto
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reuven Tsabari
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Pediatric Pulmonology Unit and Cystic Fibrosis Center, Pediatric Department, Hadassah Medical Center, Jerusalem, Israel
| | - Elie Picard
- Shaare Zedek Medical Center affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Patrick Stafler
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Aviv D Goldbart
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Micha Aviram
- Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dvir Gatt
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Romi Bari
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergey Tsaregorodtsev
- Department of Anesthesia and Critical care, Soroka University Medical Center, Beer-Sheva, Israel
| | - Chilaf Peled
- Department of Otolaryngology Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Pesah Melnik
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Haifa, Israel
| |
Collapse
|
9
|
Chebib E, Benoit C, Van Den Abbeele T, Teissier N. PEANUTS: a national survey on the management of pediatric tracheobronchial foreign bodies. Eur J Pediatr 2023; 182:591-600. [PMID: 36394648 DOI: 10.1007/s00431-022-04706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
Abstract
To assess the different types of management of pediatric foreign body aspirations in order to help define guidelines, depending on clinical presentation. A national survey in France was emailed to all 30 university-affiliated departments of otolaryngology-head and neck surgery and pediatric pulmonologists in France. Data concerning the center and the experience of each participant were collected in order to define an "senior expert" group with experience of extracting more than 10 foreign bodies and a "junior/non-expert" group. Both groups answered questions concerning five clinical cases of foreign body aspiration of different severities. Ninety-eight participants answered this survey (75 otolaryngologists and 23 pulmonologists), representing 28 of the 30 university-affiliated departments in France with a completion rate of 89%. Responses of the senior expert group were similar for clear-cut situations, such as an asymptomatic child with a low probability of foreign body aspiration and for a symptomatic child with respiratory distress. However, for intermediate situations, management varied significantly according to the physician when considering clinical, radiological, and surgical management. In comparison to the senior expert group, the junior non-expert group seemed more precautious in the management of foreign body aspiration for intermediate cases, in particular, concerning the time at which extraction was performed. Conclusion: The management of foreign body aspiration depends on the physician's experience and the center's habits. In order to optimize patient care for foreign body aspiration, we suggested a management algorithm based on the senior expert group responses. What is Known: • Foreign body aspirations (FBA) are dreaded by pediatricians, pediatric otolaryngologists, and pulmonologists particularly because of the potential fatal outcome. • However, consensus concerning their management is not clearly defined in the literature. What is New: • This study is the first to evaluate the management of foreign body aspirations (FBA) from the clinical assessment by the emergency medicine physician to the extraction of the foreign body. • A management algorithm was designed and secondarily validated by the SE group to help to emergency medicine physician and specialist to manage FBA.
Collapse
Affiliation(s)
- Emilien Chebib
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medicine, Paris University, 48 Boulevard Sérurier, 75019, Paris, France.
| | - Charlotte Benoit
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medicine, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Thierry Van Den Abbeele
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medicine, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Natacha Teissier
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medicine, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| |
Collapse
|
10
|
Shao H, Li S, He J, Wu L, Chen Z. A combination of flexible and rigid bronchoscopy in the successful removal of a residual fish bone from a peripheral bronchus: A case report. Front Pediatr 2023; 11:1114043. [PMID: 36896398 PMCID: PMC9989009 DOI: 10.3389/fped.2023.1114043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
Although rigid bronchoscopy remains the gold standard for the management of foreign body (FB) inhalation, sometimes it still misses residual FBs. Inhalation of sharp FBs by infants is an uncommon but hazardous occurrence, which presents a significant challenge and demands expertise in therapeutic bronchoscopy. Particularly, residual sharp FBs in the peripheral tracheobronchial tree may pose challenging management problems for bronchoscopists. Herein, we describe the case of 1-year-old girl, who presented with persistent atelectasis in the left lower lobe for 20 days without responding to antibiotic therapy after removal of fish bone by rigid bronchoscopy at local hospital. Flexible bronchoscopy at our department showed a residual fish bone in the outer basal segment of the left lower lobe. A combined flexible and rigid bronchoscopy was then applied, and a fish bone measuring 1.5 cm in length was extracted on multiple attempts without any complications. Thus, our reports demonstrated that removal of challenging residual sharp FBs in the distal airways is possible with the aid of combined flexible and rigid bronchoscopy by an experienced multidisciplinary team. Additionally, a physician should pay special attention to abnormal chest images after removal of FBs.
Collapse
Affiliation(s)
- Hanqing Shao
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shuxian Li
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jing He
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lei Wu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhimin Chen
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| |
Collapse
|
11
|
Zhang SJ, Gu HB, Zhou M, Lin MY, Zhang LX, Chen XY, Lu GL. Risk factors associated with reintubations in children undergoing foreign body removal using flexible bronchoscopy: a single-center retrospective cross-sectional study. BMC Anesthesiol 2022; 22:219. [PMID: 35831787 PMCID: PMC9277839 DOI: 10.1186/s12871-022-01756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/01/2022] [Indexed: 11/27/2022] Open
Abstract
Background Reintubation is a severe complication during foreign body (FB) removal that uses flexible bronchoscopy. Objective To investigate the incidence and risk factors for reintubations in children undergoing FB extraction by flexible bronchoscopy in a single center. Design A retrospective cross-sectional study. Setting All children with foreign body aspiration at Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University from January 2015 to December 2020. Patients Children with FB removal using a flexible bronchoscopy were enrolled in the trial according to the inclusion criteria. Measurements Both multivariable and logistic regression analyses were used to analyze the association between characteristic data and reintubations. The results were presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results In total, 244 patients met with the inclusion criteria and were included in the analysis. Among those participants, 28 children (11.5%) underwent reintubations after FB removal by flexible bronchoscopy. Independent factors associated with reintubations were identified as operative time ≥ 60 min [OR: 3.68, 95% CI (1.64–8.82)] and ASA ≥ III [OR: 5.7, 95% CI (1.23–26.4)]. Conclusions Children undergoing FB removal by a flexible bronchoscopy may encounter with a high incidence of postoperative reintubations. Both long operative duration and a severe physical status cause a growing risk of reintubations.
Collapse
Affiliation(s)
- Su-Jing Zhang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Department of Anesthesiology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children's Hospital, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China
| | - Hong-Bin Gu
- Department of Anesthesiology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children's Hospital, Fuzhou, China.,Department of anesthesia, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, China
| | - Min Zhou
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Department of Anesthesiology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children's Hospital, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China
| | - Min-Yi Lin
- Department of Anesthesiology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children's Hospital, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China
| | - Long-Xin Zhang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China
| | - Xiu-Ying Chen
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China
| | - Guo-Lin Lu
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China. .,Department of Anesthesiology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children's Hospital, Fuzhou, China. .,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China.
| |
Collapse
|
12
|
Moslehi MA. Failures in emergency management of pediatric airway foreign bodies by rigid bronchoscopy: we have yet to complete our learning. World Jnl Ped Surgery 2022; 5:e000321. [DOI: 10.1136/wjps-2021-000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/03/2022] [Indexed: 11/04/2022] Open
Abstract
BackgroundSeveral children are affected by airway foreign body aspiration (FBA) resulting from life-threatening conditions. Choking has been considered the major symptom and is defined as airway blockage by a foreign body (FB), leading to marked morbidity or mortality. This retrospective study indicates the possibility of misdiagnosis or rigid bronchoscope (RB) failure, which is the standard gold method for extracting FB in the airway.MethodsSix children with airway FBA who failed treatment using RB between 2018 and 2019 were retrospectively studied. The inclusion criterion was a history of failure to extract FB using RB followed by flexible fiberoptic bronchoscopy (FFB).ResultsIn the present study, among 63 patients who had undergone rigid bronchoscopy, airway FBs were successfully removed in 57 (90.48%). Rigid bronchoscopy failed in 6 (9.52%) patients. The age of cases at the time of bronchoscopy ranged from 11 months to 13 years. FFB was performed to extract missing or remaining FBs and was done successfully in all patients. The patients made an uneventful recovery following FB extraction using the FFB method.ConclusionsIt is not easy to diagnose and treat airway FB in children. Rigid bronchoscopy has been approved as a method to manage airway FB, but a negative bronchoscopy result must usually be interpreted carefully. FFB is applicable as a proper and relatively safe diagnostic and therapeutic tool in managing airway FBs among the pediatric population, especially in cases where rigid bronchoscopy was performed but missed or failed to extract the FB.
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW Anesthesia for pulmonological interventions is a demanding challenge. This article discusses recent innovations and the implications for periinterventional anesthetic management. RECENT FINDINGS Interventional pulmonology is a rapidly expanding specialty with very complex diagnostic and therapeutic approaches that include oncological staging, treatment of obstructive and restrictive lung diseases, recanalization of endobronchial obstructions, and retrieval of foreign bodies. With the development of advanced diagnostic and therapeutic interventions, the application is extended to critically ill patients. Current evidence focusing on the anesthetic techniques is presented here. SUMMARY The development of new pulmonological methods requires a tailored anesthesiological approach. Their specific impact must be taken into account to ensure patient safety, goal-oriented outcome diagnostics and -quality, successful interventions, and patient comfort.
Collapse
Affiliation(s)
- Axel Semmelmann
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79110, Germany
| | | |
Collapse
|
14
|
Gharaibeh S, Hamouri S, Al Sharie S, Haddad F, Araydah M. Asymptomatic fixed partial denture aspiration: A case report. Ann Med Surg (Lond) 2021; 66:102391. [PMID: 34040775 DOI: 10.1016/j.amsu.2021.102391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/28/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction and importance Foreign body aspiration (FBA) is more frequently presented in children and considered a rare presentation in adults. One of the most common causes of FBA in adults are orthodontic appliances. Case presentation We present a case of a 70-year-old male with an accidently discovered fixed partial denture (bridge) in the right mainstem bronchus. The partial denture was removed successfully by flexible bronchoscopy. Clinical discussion FBA is an event that most frequently occurs with children, and rarely with adults having various risk factors and complications on patients. Conclusion This study aims to spotlight the danger of asymptomatic FBA and how retrieving sharp objects can be managed by flexible bronchoscopy thus leading to better management and increased awareness of such cases. Foreign Body Aspiration (FBA) is very uncommon in adults. Dental procedures and appliances are considered the second most common leading cause of FBA. High level of physicians' susception is needed to identify FBA cases in adults is needed. Flexible bronchoscopy has an important role in retrieving aspirated foreign bodies.
Collapse
|