Disabling the lower respiratory ways in children with foreign bodies

Abstract

Introduction. Aspiration of the foreign body is the accidental penetration by pharynx and larynx of objects or pieces of objects, food in the lower airways, which produce a state of asphyxia with vital danger to the child. Material and methods. A retrospective study was performed on a group of 123 children aged 11 months -16 years, hospitalized for the period 2013-2017 at the Mother and Child Institute. Diagnosis at admission: pneumonia, bronchopneumonia or foreign body suspected in respiratory tract.In order to establish the diagnosis, paraclinical methods - radiography and bronchoscopy were used. Of the total number of patients, 81 (65.8%) and 42 (34.1%) were hospitalized in an emergency.Endoscopic diagnosis and foreign body extraction were performed with two types of bronchoscopes: Karl Sorz pediatric rigid bronchoscope and flexible BF 3C 160 and BF 1TQ 170 Olympus videobronchoscope. Clinical cases of the greatest difficulty have been resolved by a mixed approach.The origin of foreign bodies: organic - 79 (64.2%), inorganic in 44 (35.7%) children. The location of foreign bodies was the following: tracheal level -1.8%, right bronchus lumen - 64.7%, and left - 33.5%. Associated decubitus lesions were present in 11.3% of cases. Granular masses at the foreign body level were documented in 67.2% (34.2% of them were with the duration of the presence of the foreign body up to 7 days). Contact bleeding during extraction occurred in 16.7% of cases. In 4,8% cases the bronchial mucosa was not affected. In 5 cases (4.0%) the foreign body was deeply incarcerated in the bronchial wall. Results. Extraction of foreign bodies by flexible videobronchoscope was obtained in 7 patients (5.6%). By rigid bronchoscope foreign bodies were extracted from 111 patients (90.2%). In 5 children (4.0%) access to visualization to the foreign body was possible via flexible videobronchoscope, but extraction – via rigid bronchoscopy. Conclusion. In the pediatric prenatal extraction of foreign bodies in the lower respiratory tract, the main part belongs to rigid apparatus bronchoscopy with the selection of the age-appropriate insertion tube.