Clinical features and treatment outcomes of airway foreign body aspiration in adults

Abstract

Background: There are few reports comparing flexible and rigid bronchoscopy in adult foreign body (FB) aspiration. The aim of this retrospective study was to review the clinical characteristics, outcomes and factors associated with success in adult patients who underwent flexible or rigid bronchoscopy for airway FB removal.

Methods: We retrospectively reviewed the records of 103 patients who underwent bronchoscopy to remove airway FB at Samsung Medical Center, South Korea from January 1999 to March 2017.

Results: The median patient age was 64 years, and 70% were males. Among the 54 patients who underwent flexible bronchoscopy as first-line treatment, 43 (80%) patients had their FB successfully removed. Previous attempts at other hospitals was significantly associated with failed flexible bronchoscopy [9/11 (82%) vs. 3/43 (7%), P<0.001]. Delayed diagnosis (median 29 vs. 5 days, P=0.074) and peripherally located airway FB [9/12 (75%) vs. 23/48 (48%), P=0.115] were factors that trended towards flexible bronchoscopy failure. All of the 59 patients who underwent rigid bronchoscopy had their FB successfully removed. Rigid bronchoscopy was preferred to flexible bronchoscopy in patients with no comorbidities [38/59 (64%) vs. 18/44 (41%), P=0.018], previous attempts at other hospitals [34/59 (58%) vs. 4/44 (9%), P<0.001], delayed diagnosis (median 162 vs. 5 days, P<0.001), and hard FBs [48/62 (77%) vs. 21/49 (43%), P<0.001].

Conclusions: Our data suggest that previous failed attempts and delayed diagnosis are associated with flexible bronchoscopy failure. However, rigid bronchoscopy could be effective in removing an airway FB even in these cases. Further studies to identify factors to facilitate optimal patient selection will minimize failure rates and optimize resource utilization.

Keywords: Airway foreign body; flexible bronchoscopy; rigid bronchoscopy.

Figure 1

Location of 111 foreign bodies in the tracheobronchial tree in 103 patients. There was a total of 68 foreign bodies in the right lung, 40 in the left lung and 3 in the trachea.

Figure 2

The clinical course of patients with airway foreign body aspiration. *, the patient underwent left lower lobectomy three years after airway foreign body removal because of a broncho-esophageal fistula causing recurrent pneumonia; ^†, initially, the FB caused a total airway obstruction, but it was successfully removed. However, six weeks later, bronchial stenosis occurred and an airway silicone airway stent was inserted; ^§, removed with flexible bronchoscopy under mechanical ventilation because of severe cough and noncooperation.