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© Borgis - New Medicine 1/2020, s. 15-19 | DOI: 10.25121/NewMed.2020.24.1.15
Irina Drogobytska, Maciej Pilch, *Lidia Zawadzka-Głos
The foreign bodies in lower respiratory tract in pediatric patients treated in referral academic department of pediatric otolaryngology
Ciała obce w dolnych drogach oddechowych u dzieci leczonych w referencyjnym laryngologicznym os?rodku akademickim
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Lidia Zawadzka-Głos, MD, PhD
Streszczenie
Wstęp. Ciała obce dolnych dróg oddechowych od wielu lat pozostają wyzwaniem dla laryngologów. Ciało obce w dolnych drogach oddechowych może prezentować znaczną zmienność objawów klinicznych. Opóźnienie rozpoznania wiąże się ze zwiększeniem zachorowalności i śmiertelności. Dokładny wywiad jest bardzo ważny w diagnostyce ciała obcego. Każde podejrzenie aspiracji kwalifikuje pacjenta do diagnostycznej bronchoskopii.
Cel pracy. Celem pracy była ocena występowania, przebiegu klinicznego, diagnostyki oraz sposobu leczenia dzieci z podejrzeniem aspiracji ciała obcego w materiale akademickiego referencyjnego oddziału laryngologii dziecięcej.
Materiał i metody. Analizą retrospektywną objęto 74 pacjentów z podejrzeniem ciała obcego w dolnych drogach oddechowych, którzy byli hospitalizowani w Klinice Otolaryngologii Dziecięcej Warszawskiego Uniwersytetu Medycznego w latach 2016-2018. Analizie poddano dane demograficzne, częstość występowania, lokalizację i rodzaj ciał obcych, postępowanie diagnostyczne oraz zastosowane leczenie.
Wyniki. Do badania włączono 42 chłopców (57%) i 32 dziewczynki (43%) w wieku od 8 miesięcy do 16 lat. Epizod zakrztuszenia się w wywiadzie występował u 71 (96%) pacjentów. U 44 dzieci (59,5%) stwierdzono ciała obce w dolnych drogach oddechowych, które zostały usunięte. U 30 osób (40,5%) nie stwierdzono ciał obcych. Najczęściej ciała obce stwierdzono u dzieci w wieku 1-3 lat, co stanowiło 22 przypadki (50%). Najczęstszymi dolegliwościami były: kaszel (54,5%), świszczący oddech (27,2%) i duszność (15,9%). U 23 (43,2%) pacjentów stwierdzono świsty i furczenia w badaniu przedmiotowym. Rentgen klatki piersiowej wykazywał cechy pułapki powietrznej u 22 (45%) przypadków. Najczęstszym miejscem zalegania ciała obcego było oskrzele główne prawe (22; 50%). Organiczne ciała obce obecne były w 32 (72,7%) przypadkach, a nieorganiczne ciała obce – w 12 (27,3%). Najczęściej aspirowanymi przedmiotami były fragmenty orzeszków.
Wnioski. Aspiracja ciała obcego powinna być podejrzewana u każdego dziecka nie tylko z epizodem zakrztuszenia się w wywiadzie, ale także z niejednoznacznymi zmianami w badaniu przedmiotowym i radiologicznym.
U dziecka z podejrzeniem ciała obcego w drogach oddechowych należy wykonać bronchoskopię, nawet jeśli nie stwierdzono odchyleń w badaniu przedmiotowym i badaniu radiologicznym.
Summary
Introduction. Foreign bodies in lower respiratory tract for many years are big challenge for otolaryngologists. These objects could present variability of clinical symptoms. Increase of infection and mortality due to delay of accurate diagnosis. Interview is the most important part of examination of patient with suspected foreign body in airways. Any suspicion of aspiration is qualification to diagnostic bronchoscopy.
Aim. This paper refers occurrence assessment, clinical course, diagnostic process and treatment of the pediatric patients with suspected foreign body in lower respiratory tract hospitalized in referral Academic Department of Pediatric Otolaryngology.
Material and methods. Retrospective analysis of 74 patients with suspected foreign body in lower respiratory tract, who were hospitalized in Clinical Department of Pediatric Otolaryngology in Warsaw Medical University in 2016-2018. Analysis includes demographic data, occurrence frequency, localization and the type of foreign body, diagnostic process and treatment.
Results. This study includes 42 boys (57%) and 32 girls (43%) in age of 8 months to 16-year-old. The episode of choking occurs in interview in 71 patients (96%). Foreign bodies in lower respiratory tract were confirmed and evacuated in bronchoscopy procedure in 44 cases (59.5%). In 30 cases (40.5%) there were any foreign body in airways. The most common group of patients admitted to Clinic with suspected foreign body in airways was children in age between 1 to 3-year-old, which accounted for 22 cases (50%). Coughing was the most commonly reported symptom (54.5%), wheezing (27.5%) and dyspnea (15.9%). Twenty-three patients were presenting wheezing and whirring in physical examination. Air trap found in thorax x-ray were in 22 patients (45%). The right main bronchus was the most common place of foreign body retention – 22 patients (50%). The organic foreign bodies were in 32 cases (72.7%) and non-organic in 12 (27.3%). The nuts were the most common foreign body aspirated to airways.
Conclusions. Foreign body aspiration should be suspected in every patient, not only those with choking episode but also with patients who presents ambiguous change in physical examination and x-ray scan.
In pediatric patient with suspected foreign body in lower respiratory tract, in every time the bronchoscopy is needed to be done, even in patients with no abnormalities in physical examination and x-ray scan.
Introduction
Foreign bodies in lower respiratory tract for many years are great diagnostic and therapeutic challenge for otolaryngologists (1). The foreign bodies are most often found in patients of age 1 to 3-year-old, rarely in infants or older children at school age (2, 3). Very important indicator of aspiration the foreign body to airways is occurrence of episode of sudden choking after which appears severe cough in children during eating or having fun (4).
Foreign body in lower respiratory tract could be presenting a significant variability of clinical symptoms, from minimal, often unnoticeable to very severe, in some cases lethal due to acute respiratory failure (1, 3, 5). Symptoms depends of localization, size, consistency and time of retention of foreign body (1, 3, 5). Morbidity and mortality are directly related to diagnosis delay (6). Thorough interview is very important because in some cases patient are not presenting any symptoms in physical examination (6). In pediatric patients admitted with suspected foreign body in lower respiratory tract the result of thoracic x-ray scan can be normal or can present abnormalities unusual to aspiration of foreign body (7). Any patient suspected of foreign body aspiration should be qualified to diagnostic bronchoscopy (8). Rigid bronchoscopy is preferred method of foreign body removal in pediatric patients (9-11).
Aim
This paper refers occurrence assessment, clinical course, diagnostic process and treatment of the pediatric patients with suspected foreign body in lower respiratory tract hospitalized in referral Academic Department of Pediatric Otolaryngology.
Material and methods
Retrospective analysis of 74 patients up to 16-year-old with suspected foreign body in lower respiratory tract, who were hospitalized in Clinical Department of Pediatric Otolaryngology in Warsaw Medical University in 2016-2018. Analysis includes demographic data, occurrence frequency, localization and the type of foreign body, diagnostic process and treatment.
Results
This study includes 42 boys (57%) and 32 girls (43%) in age of 8 months to 16-year-old (avg. 3.3 y.o. ± 3.34 y.; med. 2.25). Patients were qualified to bronchoscopy on the basis of choking episode in subject examination, presenting clinical symptoms and radiological examination – thorax x-ray scan. In 3 cases there were no choking episode noticed by parents, however presented symptoms and no improvement after conservative treatment caused qualification for further diagnostic in direction of foreign body in airways. All the patients were subjected to rigid bronchoscopy in general anesthesia. In 44 cases (59.5%) there were foreign body in lower respiratory tract which have been removed. In the remaining 30 patients there were no foreign body found in bronchoscopy.
In occurrence of choking episode (98 vs. 93%) and changes in radiological examination (68 vs. 63%) there were no significant differences found in the comparison of patient groups with and without foreign body found in bronchoscopy. However, it was more frequent with abnormalities in physical examination (80 vs. 37%, p < 0.00019) (fig. 1).
Fig. 1. Comparison of indications to bronchoscopy with division into patients with and without foreign bodies in lower respiratory tract
Patients with foreign body in lower respiratory tract were subjected to further analysis in terms of age, sex, delay in admitting to the hospital, clinical symptoms, results of radiological examination, type and localization of foreign body.
From 44 patients the most numerous group are children in age between 1 to 3-year-old which was 22 cases (50%). The youngest patient was 8 months old and the oldest have 16-year-old. The boys in this case were 29 cases (65,9%), girls were 15 cases (34,1%) (tab. 1).
Tab. 1. Table with demographic data of patients of group with foreign body found in lower respiratory tract
Sex\Age (y)8/12-11-33-66-99-16Total
Boys6 (13.6%)12 (27.3%)7 (15.9%)1 (2.3%)3 (6.8%)29 (65.9%)
Girls2 (4.6%)10 (22.7%)3 (6.8%)15 (34.1%)
Total8 (18.2%)22 (50%)10 (22.7%)1 (2.3%)3 (6.8%)44
The fastest time from choking episode to admission to hospital was 6 hours, but the latest after 24 days. The delay between choking episode and admission time was presented in table 2.
Tab. 2. Time between choking episode and admission to hospital
Time (days)Number of casesPercent
11636.4
21840.9
3-649.1
7-1024.5
11-2036.8
> 2012.3

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Piśmiennictwo
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2. Nader S, Sohelia N, Fakher R et al.: Foreign body aspiration in infancy: a 20-year experience. Int J Med Sci 2009; 6(6): 322-328.
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5. Darrow DH, Holinger LD: Foreign bodies of the larynx, trachea and bronchi. Pediatric Otolaryngology. 4th ed. WB Saunders Company, Philadelphia 2002: 1543-1557.
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15. Kalyanappagol VT, Kulkarni NH, Bidri LH: Management of Tracheobronchial foreign body aspiration pediatric age group – A ten year retrospective analysis. Indian J Anaesth 2007; 51(1): 20-23.
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otrzymano: 2020-01-27
zaakceptowano do druku: 2020-02-17

Adres do korespondencji:
*Lidia Zawadzka-Głos
Klinika Otolaryngologii Dziecięcej Warszawski Uniwersytet Medyczny
ul. Żwirki i Wigury 63A, 02-091 Warszawa, Polska
tel.: +48 (22) 317-97-21
laryngologia@spdsk.edu.pl

New Medicine 1/2020
Strona internetowa czasopisma New Medicine