Paediatrics: Foreign-body inhalation

2021-03-10 12:00 AM

Foreign-body (FB) aspiration is more common in toddlers and infants, who tend to put objects in their mouths.

Foreign-body inhalation

Foreign-body (FB) aspiration is more common in toddlers and infants, who tend to put objects in their mouths. FBs can be inhaled into the airway, or they may get caught in the oesophagus and compress the trachea.

Symptoms

The symptoms of a FB in the aerodigestive tract range from no symptoms to complete airway obstruction.

  • Larynx: usually causes hoarseness, cough, dysphonia, haemoptysis, stridor, wheezing, dyspnoea, cyanosis, or apnoea due to complete obstruction.
  • Trachea and bronchus: can cause chest pain. After initial symptoms, there may be an asymptomatic period followed by features of pneumonia.
  • Oesophagus: will produce drooling, dysphagia, or vomiting and, if the trachea is compressed, may produce dyspnoea, stridor, respiratory failure, or apnoea.

Aetiology

  • Inhaled FB should be considered in all patients with a history of choking or gagging.

Diagnosis

  • A monophonic wheeze or absent breath sounds on one side of the chest may be noted on examination.
  • Chest and neck radiographs, with lateral views, may be helpful in identifying the location of an object. Inspiratory and expiratory films may show an area of hyperinflation.
  • Arterial blood gas analysis is indicated when the patient is in severe distress.

Initial treatment

Follow a standard protocol.

  • ABC.
  • FB removal: if the child is calm with good air exchange, removal of the FB should take place under controlled circumstances; manipulation may change the position of the object, inducing more severe obstruction. If the child is in distress but maintaining good air exchange, back blows and chest thrusts may be performed as per the standard technique for paediatric advanced life support (ALS).
  • An unconscious child with poor air entry should be given oxygen (FiO2100%) via a face mask until rigid bronchoscopy and object removal can be performed.