Foreign bodies in the respiratory tract

Proven content

Foreign bodies enter the respiratory tract more often in children than in adults. They rarely stop in the larynx, but usually enter the trachea or bronchus through the mouth or nose. They can be different, small items, usually less than those that are stuck in the esophagus, e.g. pins, nails, buttons, parts of dentures.

A few words about foreign bodies in the respiratory tract …

Foreign bodies in the respiratory tract are a serious problem, especially in children. Most often it concerns children aged 1-3 years, in whom the larynx and trachea differ significantly from the larynx of older children and adults (anatomical differences can be noticed). Foreign bodies are relatively rarely left in the larynx, usually passing further into the trachea or bronchi through the mouth or nose. Swelling foreign bodies such as beans and peas are dangerous. On the other hand, in unconscious people, blood or vomit may get into the respiratory tract. Foreign bodies usually enter the respiratory tract as a result of rushing eating and inaccurate chewing, and by putting pins, needles or nails in the mouth.

Individual periods in the course of the disease caused by foreign body aspiration

In the course of ailments caused by the ingress of a foreign body into the respiratory tract, there are four periods:

1. the period of acute obstruction – then there is a violent, short attack of coughing or repeated attacks. The most sensitive are the upper parts of the lower respiratory tract, i.e. the split bronchus and trachea;
2. the oligosymptomatic period – a foreign body that has entered the bronchi and is wedged there is surrounded by the mucosa. Symptoms slowly resolve depending on the bronchial lumen;
3. the period of acute inflammatory complications of the bronchi and lungs – characterized by symptoms characteristic of pneumonia, and the development of bacterial infection occurs after several days of the oligosymptomatic period;
4. period of permanent bronchopulmonary injuries – this is recurrent inflammation, which primarily causes bronchial obstruction and permanent damage, e.g. inflammatory cysts, bronchiectasis or lung abscess. Accompanying symptoms may include fever, cough and bleeding from the airways.

What symptoms does a foreign body cause in the respiratory tract?

Sharp objects can injure the mucosa and cause hemoptysis, which is preceded by pain behind the sternum, while swelling foreign bodies cause shortness of breath. Sometimes (especially in children) foreign bodies in the trachea or bronchi do not give any symptoms. Only later changes in the bronchi and lungs may suggest that there is a foreign body in the airways.

Long-lasting cough and low-grade fever are non-typical symptoms.

On the other hand, important symptoms resulting from the presence of a foreign body in the respiratory tract are:

1. problems with lung ventilation: more often atelectasis, less often ventricular emphysema. Lung ventilation may occur due to obstruction of the bronchi with a foreign body, edema, or the formation of a foreign body valve.

Inflammation can occur in atelastic or distended lung tissue, and because antibiotics do not remove the cause but eliminate the infection, it can lead to:

1. haemorrhages (rare)
2. complications in the form of dilatation and cirrhosis,
3. pneumonia that returns in the same place,
4. lung abscess complication of pneumonia.

What foreign bodies can get into the respiratory tract?

In both adults and children, everything that has found its way into the mouth for various reasons can get into the airways. The size of the foreign body is very important. The greatest danger is caused by large pieces of food that block the vestibule of the larynx or the trachea. It can even result in suffocation and death. Swelling foreign bodies in the form of seeds or sponges are also dangerous, which can cause symptoms of bronchial obstruction (atelectasis or ventricular emphysema).

There is a group of foreign bodies that can remain in a patient’s bronchial tubes for a long time without showing any symptoms. Such items are needles, pins or wires.

Wandering foreign bodies – they are dangerous because when coughing they like to move towards the lung and penetrate the bronchus of the opposite lung. How the foreign body is located in the bronchus depends not only on its size, but also on the position of the little patient at the time of choking.

According to research, foreign bodies are usually located in the lower right lobe of the bronchus, then the left lower lobe, but much less frequently into the middle lobe of the bronchus or upper left or right bronchus.

Foreign body diagnostics in the respiratory tract

Diagnostics is based primarily on a thorough medical interview with the patient. Unfortunately, sometimes the symptoms in the form of dyspnea or cough are often ignored by parents, therefore the diagnosis is often made very late. During the interview, the doctor should carefully ask the parents about the child’s dyspnea, cyanosis, vomiting and choking. The circumstances of the preceding symptoms should also be established.

Next, general and otolaryngological examinations are performed. During the examination, the doctor is able to recognize specific wheezing or changes in e.g. chest percussion. In addition, physical examination most often diagnoses elevated body temperature, wheezing, circulatory and respiratory failure, and weakened alveolar murmur.

Imaging tests play an important role in diagnostics, sometimes they are the final method needed to fully reveal a foreign body in the respiratory tract. The basic examination is a chest X-ray, which is performed in oblique, lateral or anterior-posterior projections. In the case of differentiation of the foreign body with other inflammatory conditions, a lateral X-ray of the larynx and trachea is performed. The above-mentioned methods allow to visualize the presence of foreign bodies and their exact location even in 90% of cases.

Less frequently performed tests are:

1. stratified test,
2. bronchography,
3. scintigraphic examination after administration of the inhaled radioactive tracer.

Treatment

Treatment is possible only in specialized institutions equipped with instruments for the removal of foreign bodies.

At the slightest suspicion that a foreign body has entered the respiratory tract, it is necessary to transport the patient immediately for examination to the laryngological, pulmonary or pediatric emergency department. The patient requires direct laryngoscopy or bronchoscopy and removal of the foreign body. If a foreign body is wedged in the larynx, a cricothyroid or tracheotomy is required. Suspicion that a foreign body is acutely absorbed into the respiratory tract should be an indication for bronchoscopy.

Bronchoskopia – is a procedure performed under general anesthesia in the operating room. It is considered the best method of removing a foreign body from the respiratory tract. Of course, you need endoscopic equipment and the equipment necessary for intubation and possible resuscitation. Removal of a foreign body during bronchoscopy is not always simple and non-traumatic. Unfortunately, an unrecognized foreign body causes swelling and inflammation of the mucosa in the bronchi, which completely or partially obstruct access to the foreign body. This is an obstacle in bronchoscopic removal of it from the bronchi (especially granulation bleeding hinders the visibility and extends the duration of the procedure).

Complications of bronchoscopy

1. a foreign body sticking into the bronchial wall,
2. bronchial mucosa trauma,
3. loss of visibility of a foreign body,
4. tearing a bronchus or trachea when pulling a foreign body,
5. bleeding,
6. complete inability to reach a foreign body and remove it during bronchoscopy,
7. mediastinal or subcutaneous emphysema.

Children after bronchoscopy should be under x-ray and pediatric supervision. Sometimes it is necessary for two years in cases of risk of complications. Bronchoscopy is currently believed to have completely healed in approximately 99% of cases. Late diagnosis of a foreign body causes an increased percentage of possible complications.

Pre-treatment in children

If the child has obstruction of the respiratory tract, and thus loss of consciousness, place them on a flat and hard surface. Then it is necessary to call an ambulance. Under no circumstances should you leave your child unattended.

Before help arrives:

1. open the child’s mouth and see if there are any visible foreign bodies inside,
2. if you notice any object inside the mouth, try to remove it once with your finger,
3. remember not to delete anything blindly,
4. do not repeatedly try to remove the foreign body as you can inadvertently push it deeper into the larynx and cause injury,
5. then clear the child’s airway by tilting his head and protruding the jaw, and then give five rescue breaths,
6. if the chest does not rise despite inhaling, correct the position of the head before trying again,
7. perform 5 attempts to rescue breathing – if they do not work, start compressing the chest,
8. follow the CPR algorithm for one rescuer for about a minute before calling an ambulance (if no one has done so before),
9. remember to check if there are any foreign bodies in the mouth while clearing the airways,
10. if the child begins to regain consciousness, place him / her in a safe position and observe consciousness and breathing until help is provided.

Pre-treatment in adults

1. Adult partial airway obstruction – encourage him to cough.

2. Complete respiratory obstruction without unconsciousness – perform up to 5 blows in the interscapular area. You have to stand behind the patient, a little to the side, and place one hand on his chest and bend him forward so that the foreign body does not slide any further. Then apply five vigorous strokes with the wrist of your hand in the interscapular area and check after each of them whether any foreign body accidentally spills out.

3. If the blows between the shoulder blades were unsuccessful, apply abdominal pressure. Lean the patient forward and embrace the upper abdomen from behind, then place a clenched fist between the navel and the xiphoid process. With your free hand, grasp the clenched fist and pull it upwards with all your strength. Repeat five times.

4. Loss of consciousness in an adult:

1. put the sick person on the ground,
2. call an ambulance,
3. start cardiopulmonary resuscitation.

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