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.