Abstract
Background:Tracheobronchial foreign body aspiration (TFBA) is a major cause of death in children. There are few reports about lower respiratory tract infection (LRTI) caused by TFBA. This study collected the TFBA in our hospital to analyze the LRTI and to determine its risk factors.
Methods: A total of 194 children who were performed TFBA extraction in The Children’s Hospital of Zhejiang University School of Medicine between June 2019 and April 2020 were enrolled. The clinical data, cervicothoracic CT and operation records were collected. Chi-square test, rank sum test and multivariate logistics regression analysis were applied.
Results: The incidence of LRTI was 46.6%, 68.6% and 68.6% respectively when retention time was within 24 hours, 1 week and more than 1 week. Cervicothoracic CT showed embedding site in and above trachea in 24 cases, in main bronchus in 134 cases, in segmental bronchus and below in 36 cases. Cervicothoracic CT showed no obvious abnormality in 60 cases, obstructive emphysema or atelectasis in 77 cases, obstructive pneumonia in 50 cases, and the rest in 7 cases. Cervicothoracic CT diagnosis and retention time of TFBA were different between LRTI group and non-LRTI group in univariate analysis. There was a correlation between the retention time of TFBA and LRTI in multivariate logistics regression analysis.
Conclusionss: The incidence of LRTI caused by TFBA is high. There was no difference in the incidence of LRTI between organic and inorganic TFBA. The retention time of TFBA is an independent risk factor for LRTI.
Key words
Tracheobronchial; Foreign body; Infection; CT; Type; Children.
Abbreviations: TFBA, Tracheobronchial foreign body aspiration; LRTI, lower respiratory tract infection
1 INTRODUCTION
Tracheobronchial foreign body aspiration (TFBA) often occurs in children, and especially in children under 3 years old1. They tend to have hypoplasia of molars, poor masticatory function, weak choking ability, and they are easy to cry during dining2. In a result, the incidence of them is higher. TFBA is also a major cause of death among children3. Although the survival rate of TFBA has been greatly improved since the development of rigid bronchoscope in 19th century4,it is still a major challenge for otorhinolaryngology. The trachea of children is smaller than adults, which leads to a more limited operative field under rigid bronchoscope. Also, TFBA can easily lead to varied degrees of damage in tracheal mucosa5,such as mucosal follicular hyperplasia, hyperemia and swelling, inflammatory stenosis of bronchial lumen, blockage of bronchial lumen by purulent secretions, all resulting in an even worse operative field. Therefore, we hope to find a clinically available indicator to predict the high incidence of lower respiratory tract infection(LRTI), so that the operator can be well prepared before the operation.
Emphysema, atelectasis and pneumonia are common complications of TFBA6,however, there are few studies on LRTI caused by TFBA. Studies are mainly focused on bacterial culture7,8. According to previous studies, there was no correlation between the type of TFBA and LRTI in animal studies, whereas the retention time of TFBA was related9. A research reported that type, shape and the retention time of TFBA and age were associated with LRTI10. Therefore, we retrospectively analyzed the children who were applied TFBA extraction in our hospital in order to determine the occurrence of LRTI and analyze its risk factors.