Flexible bronchoscopic management of airway foreign bodies in children.
OBJECTIVE
To evaluate experience with the flexible bronchoscopic management of tracheobronchial foreign bodies (TFBs) in children (age < or = 16 years).


METHODS
All pediatric bronchoscopies performed by the bronchoscopy section at Mayo Clinic Rochester from 1990 through June 2001 for the suspicion of TFBs were reviewed. Information analyzed included the types of bronchoscope (rigid vs flexible) and techniques used, success rates of extraction of TFBs, and complications.


RESULTS
Of the 94 children suspected of having TFBs, 39 children (28 boys and 11 girls; mean age, 47.3 months) were found to have 40 TFBs. The flexible bronchoscope was used exclusively to extract TFBs in 24 patients, and in 2 patients in whom the rigid bronchoscopic procedure was unsuccessful. Flexible bronchoscopy was performed through an endotracheal tube in 19 children. In the other five children, the procedure was accomplished through a laryngeal mask airway (LMA). In two additional patients in whom the rigid bronchoscopic procedure was unsuccessful, the instrument served as a conduit for the passage of the flexible bronchoscope. The extraction instruments employed included ureteral stone baskets and stone forceps. Since 1994, all extractions of TFBs were successfully accomplished with the flexible bronchoscope. Complications occurred in four patients who underwent rigid bronchoscopy, and included postbronchoscopy laryngeal edema manifested by stridor, cough, and respiratory distress. These resolved quickly with medical therapy.


CONCLUSIONS
Flexible bronchoscopic extraction of pediatric TFBs can be performed safely with minimal risks and complications. In our experience, it was successful in all children in whom it was employed. Nevertheless, we caution that provisions be made to provide immediate rigid bronchoscopic management, should the attempts at flexible bronchoscopic extraction fail.
Swanson
Karen L
KL
Section of Bronchoscopy, Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Medical Center, Rochester, MN 55905, USA.
Prakash
Udaya B S
UB
Midthun
David E
DE
Edell
Eric S
ES
Utz
James P
JP
McDougall
John C
JC
Brutinel
W Mark
WM
D000293:Adolescent; D001980:Bronchi; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005547:Foreign Bodies / Q000628:therapy*; D006801:Humans; D007223:Infant; D001239:Inhalation; D008297:Male; D012189:Retrospective Studies; D014132:Trachea