RESULTS:
190 patients underwent interventional bronchoscopy for removal of
inhaled FB, eighth were eliminated; five for combined use of flexible
and rigid bronchoscopies during the same procedure and three for
ingestion rather than inhalation of FB (figure 1). 182 patients were
eligible (median age of 24 months [Inter quartile range (IQR) 16
months – 8 years], 58% males); 40 (22%) by flexible bronchoscopy
and 142 (78%) by rigid bronchoscopy. The demographic details and time
interval from admission to procedure were similar between the groups
(Table 1). Most of the FB were of organic origin (59%), located in the
right main bronchus or its distal branches (53%) and were removed by
grasping forceps (19%), when using rigid bronchoscopy or by retrieval
basket(45%), when using flexible bronchoscopy (Tables 2a & 2b).
Regarding efficacy; 88.73% of rigid bronchoscopies and 95% of flexible
bronchoscopies were successful in the removal of FB (p value=0.24). 38
out of 40 (95%) flexible bronchoscopies were successful in removing the
FB, while two had failed. In both cases, the FB was metal pin, which was
located in the left main bronchus. Both were successfully removed by
rigid bronchoscopy during the same procedure. 126 out of 142 (90%)
rigid bronchoscopies were successful in removing the FB, while 16 had
failed. Out of those that failed; 4 were successfully removed by
flexible bronchoscopy during the same procedure, 4 were successfully
removed by flexible bronchoscopy in a delayed procedure and 4 were
successfully removed by rigid bronchoscopy in a delayed procedure,
(usually 2-4 days later, after initiation of systemic steroid and
antibiotic treatment), while 2 of them required intubation and pediatric
intensive care unit (PICU) admission. 4 additional patients were
intubated and admitted to the PICU, stabilized and then, 3 were
transferred to a different hospital, where the FB was removed by
successful flexible bronchoscopy and one went through thoracotomy in our
institution with successful removal of the FB. The complication rate
during or post procedure was higher among rigid compared to flexible
bronchoscopy; 9.2% vs. 0, respectively (p value=0.047). Most of the
complications were disintegrating of the FB (n=7, 6.3%), intubation
requiring PICU admission (n=7, 6.3%) and bleeding (n=2). Some patients
had more than one complication. Out of the patients that needed
intubation; two inhaled organic FB (nut, peanut) that disintegrated, two
inhaled metal pin (Hijab) and two had plastic pen cover, that turn out
to be one of the most difficult FB to remove, due to its round shape and
slippery characteristic. One patient was intubated before the
bronchoscopy and not as a consequence of the procedure, because he was
unstable. Throughout the first period of the study (2009-2017) 118
procedures were performed; 111 (94%) rigid bronchoscopies and 7 (6%)
flexible bronchoscopies. We found no statistical significance in
procedure length between flexible and rigid bronchoscopies; 61 min’ vs.
48 min’, respectively (p value 0.408) (Table 3a). From 2017 onwards,
after implementation of the flexible bronchoscopies for extraction of
inhaled FB, 64 procedures were performed; 33 (51.6%) flexible
bronchoscopies and 31 (48.4%) rigid bronchoscopies. Procedure length
was found to be significantly shorter by 16 minutes, via flexible
compared to rigid bronchoscopy; 42 min’ vs. 58 min’, respectively (p
value 0.016) (Table 3b). No statistically significant difference was
found in LOS after rigid compared to flexible bronchoscopy (39 vs 33
hours, p value 0.649).