URTObstruction - Diseases
Introduction Physical Examination Differential Diagnosis Specific Diseases Epiglottitis Viral croup Foreign body aspiration Clinical Diagnosis Management Retropharyngeal abscess References Other Lectures		Treatment of airway FBs is laryngoscopy or bronchoscopy with removal of the object in the operating room under anesthesia. This may be a difficult procedure, especially in the very young patient with tiny airways. The FB may be too cumbersome to remove whole with the bronchoscope forceps. It also may be too friable, such as a peanut, which might crumble into many smaller pieces when grasped with the forceps, each of these smaller pieces in turn falling farther down into the distal airway. Therefore, in some cases, a Fogarty catheter or urine stone basket may be needed for removal. Similarly, esophageal FBs can be removed by endoscopic forceps with or without a Foley catheter. However, if the latter is used, the FB must be smooth without sharp edges, in place for less than 2 weeks and there must be no underlying esophageal disease. It is almost never necessary to proceed immediately to bronchoscopy. One can usually wait and schedule it electively, especially if the patient has a full stomach. In the semi-urgent situation, however, Heliox has been used successfully as a temporizing measure, allowing decreased work of breathing, better oxygenation and less distress while awaiting bronchoscopy. The endoscopic removal has certain hazards, besides the production of many smaller more distal FBs, as described above. A FB leads to a decrease in ventilation of the ipsilateral lung, which in turn leads to a reflex decrease in perfusion of that lung. If during removal of the FB, it slips from the forceps or catheters and falls into the contralateral airway, the patient will now suffer from airway obstruction on one side and continued underperfusion on the other. Plus, of course, there is the edema and trauma to the airway caused by the FB itself, as well as by the instrumentation necessary for removal. Because of this airway edema, as well as the chemical pneumonia in cases of food aspiration (especially peanuts secondary to the peanut oils), the patient with an airway FB will require respiratory care for 24 to 72 hours after FB removal. Antibiotics, steroids, oxygen, mist and chest physiotherapy may all be necessary, as well as observation in the intensive care unit. In other words, the patient with an airway FB is not dramatically improved after endoscopic removal as is the patient with epiglottitis after intubation. The risk of long-term complications increases with increased elapsed time from aspiration to diagnosis. This is especially true of aspiration of organic FBs. The complication rate can be as high as 60% in those children not diagnosed until 30 or more days after aspiration. The most common complications seen are bronchiectasis and persistent cough and wheeze. Return to top of page