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Objective: To compare clinical outcomes of flexible and rigid bronchoscopies for the management of foreign body aspiration (FBA) in different airway locations, especially in unilateral main bronchus, in children, so as to provide some suggestions to assist clinical decisions., Methods: The medical records of children diagnosed with FBA in Qingdao Women and Children's Hospital Affiliated to Qingdao University from January 2020 to June 2022 were retrospectively reviewed. The following information was collected: demographics, radiological findings, endoscopic findings, foreign body locations, duration of operation, operation cost, and intraoperative and postoperative complications., Results: 182 children were included in the study with the median age of 1.3 years (interquatile range, 1.0-1.8). Among whom, 124 cases (68.1 %) were male and 58 cases (31.9 %) were female. 11 cases (6.0 %) had the foreign bodies located in the trachea (larynx to carina), 3 cases (1.6 %) located in the trachea and lower bronchus, 1 case (0.5 %) located in bilateral main bronchus, 135 cases (74.2 %) located in unilateral main bronchus, 4 cases (2.2 %) located in main and lobar bronchus, and 28 cases (15.4 %) located in the lobar or segmental bronchus. Among all the included children, 84 cases (46.2 %) received rigid bronchoscopy (RB) and 98 cases (53.8 %) received flexible bronchoscopy (FB). 131 cases with the foreign bodies located in unilateral main bronchus received one type of bronchoscopy (RB or FB). They were divided into two groups according to the location of foreign body relative to the midpoint of main bronchus, the proximal bronchus group and the distal bronchus group. In the proximal bronchus group, duration of operation using RB and FB was 15 (12.5-27.5) min and 15 (14.5-30.0) min, respectively (Z = 0.000, P = 1.000). The intraoperative and postoperative complication rate using RB and FB was 15.4 % and 9.1 %, respectively (χ 2  = 0.008, P = 0.927). Operation cost of FB was significantly higher than that of RB (t = -13.396, P = 0.000). In the distal bronchus group, duration of operation using RB was 20 (13.5-25.0) min, which was drastically shorter than that of FB (25 (20.0-35.0) min) (Z = -2.947, P=0.003). Operation cost of FB was still found to be significantly higher than RB (t = -20.456, P=0.000). No significant difference was found in complication rate of RB (14.3%) compared to FB (8.3%) (χ 2 =0.251, P=0.616)., Conclusions: When foreign bodies are lodged in unilateral main bronchus, RB could be chosen as the first-choice procedure with advantages in duration of operation and operation cost, especially for patients in China. Regardless of duration of operation and operation cost, FB is also a safe and efficient therapeutic procedure to remove inhaled foreign bodies in children, except for those located in the trachea and asphyxiating foreign bodies., (Copyright © 2023. Published by Elsevier Inc.)

Background: Children frequently present for suspected foreign body aspiration, many have mild symptoms and/or negative radiographs raising the question of a radiolucent foreign body aspiration., Method: Retrospective review of patients having bronchoscopy for suspected radiolucent foreign body aspiration from 2000 to 2010 collecting demographics, history, hospital presentation, radiographic, and operative details. Pearson's correlation was used between event history, presentation, radiographic details and bronchoscopically identified foreign body with P value <0.01., Results: 138 patients, mean age 2.6 years, mean weight 15.6 kg, 68% male. Event symptoms: 81% witnessed events, 64% wheezing, 43% coughing, 39% choking, 6% stridor, and 0.7% lethargy. Hospital presentation: 70% persistent symptoms, wheezing 56%, coughing 15%, desaturations 11%, stridor 7%, choking 4%, and lethargy 1%. 92% of patients had a chest x-ray; air trapping found in 38%, and lung collapse in 21%. 2 patients received CT scans; 1 had lung collapse. Bronchoscopy identified foreign bodies in 93% of patients: food 68%, plastic 18%, non-descript 11%, rocks 3%. No correlations between event symptoms, hospital presentation, radiographs and foreign body presence., Conclusion: Event history, hospital presentation, and radiographs are insufficient in proving the absence of a radiolucent foreign body. Patients with suspected radiolucent foreign body aspiration should undergo diagnostic bronchoscopy prior to discharge., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Aim: Tracheoinnominate artery fistula (TIF) is an often fatal complication of laryngotracheal separation (LTS) for which there has been no systematic therapeutic strategy for prevention or management of TIF. The aim of this study was to establish such a strategy based on our clinical experience., Materials and Methods: From 2000 to 2010, 14 patients received LTS. We reviewed these patients to develop a therapeutic approach to prevent or manage TIF., Results: Three patients had major bleeding, and another 3 received preventive treatment before major bleeding. In the major bleeding group, 1 patient died of choking from uncontrollable hemorrhage, but the others were rescued by brachiocephalic trunk separation and/or endovascular embolization. At operation, median sternotomy with its high risk of mediastinitis was avoided. In the preventive treatment group, prophylactic brachiocephalic trunk separation was performed for 2 patients because their severe scoliosis narrowed the mediastinum, compressing the innominate artery on computed tomography. Another avoided major bleeding by converting the tracheostomy tube to a length-adjustable type., Conclusion: Tracheoinnominate artery fistula is a dramatic, often lethal complication. The strategic approach should be designed to prevent it and includes evaluation of the spinal deformity on computed tomography, brachiocephalic trunk separation at the same time as LTS, and recognizing the importance of "herald" or warning minor bleeds., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Recurrent respiratory problems are common in children with severe neurodisability, and respiratory deterioration is a leading cause of premature death in this group. Although the etiology is multifactorial, recurrent pulmonary aspiration is thought to play a significant role. Gastroesophageal reflux is known to be common, as is oral-motor discoordination. Differentiating direct aspiration of food and saliva and gastric reflux aspiration is difficult and presents a challenge in managing patients and assessing their suitability for surgical antireflux procedures. This is particularly the case when children present with predominantly respiratory symptoms, where there may be direct aspiration, reflux aspiration, neither, or both. A clinical biomarker to identify and quantify reflux aspiration would therefore be useful in surgical assessment and may also be applicable as an outcome measure for clinical trials of antireflux surgery. In this review, we discuss the evidence base behind existing and potentially novel biomarkers of aspiration in bronchoalveolar lavage fluid. We highlight the limitations of the lipid-laden macrophage index, particularly with regard to its specificity and interrater/intrarater reliability. We discuss the laboratory methods available to measure promising new biomarkers (pepsin and bile acids) and highlight their potential advantages and disadvantages. Finally, to understand how aspiration causes clinical signs and symptoms in our patients, we need to study the effect of aspirated substances on the lung, and here we review the available in vivo and in vitro literature., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Foreign body aspiration (FBA) in infants and young children is a common and potentially life-threatening event. Although studies have extensively described the signs and symptoms of suspected FBA (sFBA), only few systematically compared their value for predicting bronchoscopy results., Objectives: The objectives of this study were to describe the clinical and radiologic signs and symptoms of sFBA and to identify predictors of bronchoscopically proven FBA (pFBA)., Setting: This study was conducted at a referral tertiary university hospital with an outpatient clinic and a 90-bed pediatric unit., Methods: Signs and symptoms were retrospectively analyzed for all children who had received bronchoscopy between July 1992 and April 2000 because of sFBA. Radiologic signs of FBA were reviewed and scored by 2 independent radiologists., Results: One hundred sixty children (mean age, 2.8 years; range, 11 months to 16.8 years) were enrolled in the study. Foreign body aspiration, mostly affecting the right main bronchus, was proven bronchoscopically in 122 (76%) of these children. Independent predictors of pFBA in multivariable analyses were focal hyperinflation on chest radiograph (beta = 45.4; 95% confidence interval [CI] = 5.3-390.5; P = .001), witnessed choking crisis (beta = 18.6; 95% CI = 4.7-73.0; P < .001), and white blood cell count greater than 10,000/muL (beta = 4.2; 95% CI = 1.2-14.7; P = .026). The cumulative proportion of pFBA cases increased with the number of risk factors (0, 16%; 1, 47%; 2, 96%; 3, 100%)., Conclusions: Clinical judgment to perform bronchoscopy for sFBA was correct in 76% of the children investigated. Focal hyperinflation, witnessed choking crisis, and elevated white blood cell count were strongly associated with pFBA; bronchoscopy can be strongly recommended in the presence of at least 2 risk factors when FBA is suspected.