Foreign Body Aspiration in Pediatric Patients: Bronchoscopy Delay May Be Beneficial

Study Data

Using data from an 11-year period, Dr. Lutch recorded the time between the witnessed aspiration event (or the symptomatic period compatible with a possible aspiration) to the time of bronchoscopic retrieval, as well as intraoperative findings, postoperative complications, and days in the hospital for 40 pediatric cases of FBA.

Twenty-seven patients presented with a history of a witnessed FBA and 17 of these patients (63%) had a foreign body on bronchoscopy; patients without this history had a foreign body only 31% of the time. History of witnessed aspiration remains the single best predictor of positive foreign body aspiration. Other presenting symptoms included a choking episode, stridor, wheezing, shortness of breath, recurrent/paroxysmal cough, persistent/recurrent pneumonia, and cyanosis in the absence of known cardiac or pulmonary disease.

The median time from suspected FBA to surgical intervention was 48 hours, with a range of 45 minutes to 240 days. In patients who had a foreign body, such as a nut, piece of metal, barrette, pen cap, and candy wrapper found on bronchoscopy, the time from event to intervention was less (median 26 hours) than patients with no foreign body discovered (median 54 hours). Time intervals were measured in quartiles; patients were divided into two groups based on whether they received intervention in less than 12 hours (emergent retrieval) or between 12 and 48 hours (delayed urgent retrieval).

The time from FBA to bronchoscopy was not a significant predictor of complication rates in patients who were not in acute distress. Although no complications were found in the two cohorts, complications, such as prolonged intubation and repeat bronchoscopy, did occur in patients who underwent bronchoscopy more than 48 hours after FBA.

All patients were discharged from the hospital within four days, except for four patients who required an additional length of stay up to three days. None of these patients had evidence of FBA on bronchoscopy and were treated as inpatients for pneumonia.

Diagnosis and Treatment Recommendations

According to Dr. Lutch, all unstable children with suspected FBA require expeditious bronchoscopy, as there are some situations when an undue delay could prove disastrous, such as the aspiration of disk batteries, desiccated vegetable matter, large conforming foreign bodies, unstable foreign bodies, and those causing complete laryngotracheal obstructions. Even when the nature of the foreign body is unknown, a patient with progressive respiratory embarrassment, including worsening tachypnea, hypoxia, hypercarbia, and loss of voice should undergo emergent intervention.