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A time series observation of Chinese children undergoing rigid bronchoscopy for an inhaled foreign body: 3,149 cases in 1991-2010.

Zhang X, Li WX, Cai YR - Chin. Med. J. (2015)

Bottom Line: The survey results confirmed that hypoxemia remains the most common postoperative complication in different periods.Both controlled ventilation and spontaneous ventilation were effective during the RB extraction of the foreign body at our hospital in the modern technique period.An active respiratory symptom was commonly seen in the groups with negative findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China.

ABSTRACT

Background: In China, tracheobronchial foreign body (TFB) aspiration, a major cause of emergency episode and accident death in children, remains a challenge for anesthetic management. Here, we share our experience and discuss the anesthetic consideration and management of patients with TFB aspiration.

Methods: This was a single-institution retrospective study in children with an inhaled foreign body between 1991 and 2010 that focused on the complications following rigid bronchoscopy (RB). Data including the clinical characteristics of patients and TFB, anesthetic method, and postoperative severe complications were analyzed by different periods.

Results: During the 20-year study period, the charts of 3149 patients who underwent RB for suspected inhaled TFB were reviewed. There were 2079 male and 1070 female patients (1.94:1). A nut (84%) was the most commonly inhaled object. The study revealed a 9% (n = 284) overall rate of severe postoperative complications related to severe hypoxemia, laryngeal edema, complete laryngospasm, pneumothorax, total segmental atelectasis, and death with incidences of 3.2%, 0.9%, 1.3%, 0.3%, 0.3%, and 0.1%, respectively. The rates of preoperative airway impairment, negative findings of TFB, and adverse postoperative events have been on the rise in the past 5 years.

Conclusions: The survey results confirmed that hypoxemia remains the most common postoperative complication in different periods. Both controlled ventilation and spontaneous ventilation were effective during the RB extraction of the foreign body at our hospital in the modern technique period. An active respiratory symptom was commonly seen in the groups with negative findings.

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Diagnostic flow chart of TFB aspiration in children treated at the Eye and ENT Hospital. MJV: Manual jet ventilation; IPPV: Intermittent positive-pressure ventilation; TFB: Tracheobronchial foreign body; LMA: Laryngeal mask airway.
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Figure 1: Diagnostic flow chart of TFB aspiration in children treated at the Eye and ENT Hospital. MJV: Manual jet ventilation; IPPV: Intermittent positive-pressure ventilation; TFB: Tracheobronchial foreign body; LMA: Laryngeal mask airway.

Mentions: Institutional review board approval from the Eye and ENT (EENT) Hospital of Fudan University (Shanghai, China) was obtained; a total of 3203 charts of children (<12 years of age) with suspected inhaled foreign bodies underwent RB in 1991–2010 (past 2 decades) were reviewed. Exclusion criteria included incomplete data sets (34 cases) and an emergency invasive airway (tracheal intubation or tracheostomy) prior to the RB procedure (20 cases); therefore, a total of 3149 patients were retrospectively studied. Data included patient characteristics (age, gender, weight, respiratory system impairment), foreign body details (type, duration, location), whether anesthetic management or complications ever occurred, and interventions and outcomes. An active respiratory symptom was referred to the presence of abnormal clinical signs or laboratory examination as follows: Wheezing symptoms with asthma history and/or pneumonia, atelectasis, or bronchiectasis diagnosed by a chest X-ray. The flow chart of the diagnostic algorithm of TFB aspiration in children at the EENT Hospital is shown in Figure 1.


A time series observation of Chinese children undergoing rigid bronchoscopy for an inhaled foreign body: 3,149 cases in 1991-2010.

Zhang X, Li WX, Cai YR - Chin. Med. J. (2015)

Diagnostic flow chart of TFB aspiration in children treated at the Eye and ENT Hospital. MJV: Manual jet ventilation; IPPV: Intermittent positive-pressure ventilation; TFB: Tracheobronchial foreign body; LMA: Laryngeal mask airway.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836255&req=5

Figure 1: Diagnostic flow chart of TFB aspiration in children treated at the Eye and ENT Hospital. MJV: Manual jet ventilation; IPPV: Intermittent positive-pressure ventilation; TFB: Tracheobronchial foreign body; LMA: Laryngeal mask airway.
Mentions: Institutional review board approval from the Eye and ENT (EENT) Hospital of Fudan University (Shanghai, China) was obtained; a total of 3203 charts of children (<12 years of age) with suspected inhaled foreign bodies underwent RB in 1991–2010 (past 2 decades) were reviewed. Exclusion criteria included incomplete data sets (34 cases) and an emergency invasive airway (tracheal intubation or tracheostomy) prior to the RB procedure (20 cases); therefore, a total of 3149 patients were retrospectively studied. Data included patient characteristics (age, gender, weight, respiratory system impairment), foreign body details (type, duration, location), whether anesthetic management or complications ever occurred, and interventions and outcomes. An active respiratory symptom was referred to the presence of abnormal clinical signs or laboratory examination as follows: Wheezing symptoms with asthma history and/or pneumonia, atelectasis, or bronchiectasis diagnosed by a chest X-ray. The flow chart of the diagnostic algorithm of TFB aspiration in children at the EENT Hospital is shown in Figure 1.

Bottom Line: The survey results confirmed that hypoxemia remains the most common postoperative complication in different periods.Both controlled ventilation and spontaneous ventilation were effective during the RB extraction of the foreign body at our hospital in the modern technique period.An active respiratory symptom was commonly seen in the groups with negative findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China.

ABSTRACT

Background: In China, tracheobronchial foreign body (TFB) aspiration, a major cause of emergency episode and accident death in children, remains a challenge for anesthetic management. Here, we share our experience and discuss the anesthetic consideration and management of patients with TFB aspiration.

Methods: This was a single-institution retrospective study in children with an inhaled foreign body between 1991 and 2010 that focused on the complications following rigid bronchoscopy (RB). Data including the clinical characteristics of patients and TFB, anesthetic method, and postoperative severe complications were analyzed by different periods.

Results: During the 20-year study period, the charts of 3149 patients who underwent RB for suspected inhaled TFB were reviewed. There were 2079 male and 1070 female patients (1.94:1). A nut (84%) was the most commonly inhaled object. The study revealed a 9% (n = 284) overall rate of severe postoperative complications related to severe hypoxemia, laryngeal edema, complete laryngospasm, pneumothorax, total segmental atelectasis, and death with incidences of 3.2%, 0.9%, 1.3%, 0.3%, 0.3%, and 0.1%, respectively. The rates of preoperative airway impairment, negative findings of TFB, and adverse postoperative events have been on the rise in the past 5 years.

Conclusions: The survey results confirmed that hypoxemia remains the most common postoperative complication in different periods. Both controlled ventilation and spontaneous ventilation were effective during the RB extraction of the foreign body at our hospital in the modern technique period. An active respiratory symptom was commonly seen in the groups with negative findings.

Show MeSH
Related in: MedlinePlus