Residual airway foreign bodies in children who underwent rigid bronchoscopy

Abstract

Objective: To analyze the causes of residual airway foreign bodies in children who underwent rigid bronchoscopy in order to improve the success rate of primary surgery.

Methods: Clinical data from 1130 children with airway foreign bodies, including 736 males and 394 females aged 0.42-14 years, who underwent rigid bronchoscopy in our hospital from January 2015 to May 2018 were retrospectively collected and analyzed by cluster sampling. Clinical characteristics including sex, age, time of onset, location of the foreign body, type of foreign body and experience of surgeon were gathered. All patients were classified into two groups as Group A (with residual airway foreign bodies) and Group B (without residual airway foreign bodies) according to chest CT scans and fiberoptic bronchoscope examinations after rigid bronchoscopy. The values were compared between the two groups.

Results: Thirty-one patients with residual foreign bodies were confirmed by fiberoptic bronchoscopy among 1130 children with airway foreign bodies who underwent rigid bronchoscopy under general anesthesia. The percentage of residual airway foreign body was 2.7%. The mean age was 1.55 ± 0.46 years (range 1-3 years). There were 24 male patients (77.4%), and 7 female patients (22.6%), with a male/female ratio of 3.43:1. The time of onset was 1.0 (interquartile range: 1.0-8.0) day. There were no significant difference in age, sex and time of onset between the two groups. Most residual foreign bodies were food-related: nuts (n = 27, 87.1%), beans (n = 3, 9.7%), and one case was unclear in nature (3.2%). The residual incidence of fragile foreign bodies was higher than non-friable foreign bodies (P = 0.028). The most common residual foreign body locations were left superior lobar bronchi (32.3%), left inferior lobar bronchi (25.8%) and right inferior lobar bronchi (25.8%). The residual rate of foreign bodies for surgeons with more than 5 years of operative experience was 1.92%, and 4.25% for surgeons with less than 5 years of operation experience, showing a significant difference (P = 0.022).

Conclusion: Friable foods, the complicated structure of the bronchus tree and the surgeon's experience are important causes of residual foreign bodies in the airway. Surgeons with sufficient experience are important for the success of the procedure, which is supported by chest CT and flexible bronchoscopy.

Keywords: Bronchi; Bronchoscope; Child; Foreign bodies; Inhalation; Residual.