الفهرس 
EPIDEMIOLOGY Morbidity / MortalityOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
Tracheobronchial foreign body inhalation is a dramatic event and is one of the main causes of morbidity and mortality (118); yet is commonly missed by physicians. Early diagnosis and removal of foreign bodies must be achieved to avoid complications. Diagnosis of foreign body in the airways is still a challenge for the physicians. Only bronchoscopy gives certainty about the diagnosis (123).
The present study aimed to evaluate the effect of foreign bodies inhalation on the respiratory system and its sequelae as regards complications during and after bronchoscopy and lung recovery. The present study is a prospective interventional and follow-up, the patients were recruited from bronchology unit – pulmonary department Ain Shams University Hospitals, who were referred with clinical and/or radiological suspicion of FBI in the period of June 2013 and May, 2015.
It was conducted on 75 patients 38 females (50.67%) and 37 males (49.33%) whose ages ranged from 5 months to 60 years.
It was found that patients younger than 3 years old were 40 (53.33%) and who were older than 3 years 35 (46.66%) with insignificant statically difference. Most of the patient (82%) were associated with confirmed witness of inhalation.
The commonest risk factors associated with FB inhalation were: talking/playing while eating followed by holding objects in mouth while talking or laughing. The range of duration before presentation were from few hours to more than 9 month.
It was considered that three weeks was found to be the duration required for the patient to be categorized as early or late case.
The commonest clinical manifestations among early cases (who presented within 3 weeks) were: choking with high significant statistically difference (P <0.001) while recurrent chest infection was the commonest among the late cases (who presented after 3 weeks) with high significant statistical difference (p<0.001). Respiratory distress, fever, anorexia, loss of weight and unilateral/localized hyperinflation also were the commonest among late case with significant statistical difference p value (0.005, 0.002, 0.005, 0.028 respectively).
The commonest radiological findings were: obstructive emphysema followed by collapse then consolidation and bronchiectasis; most of these findings were on the right side.
It was illustrated that radiological evidences of FBs were either radiopaque shadow in 33.3% of patients or filling defect within airway in 21.3% while no evidence of FBs in 45.33% of patients.
The bronchoscopic procedure was done for 75 patient where FBs were found in 89.33% of the patients. It was illustrated that the commonest radiological and bronchoscopical sites were: RT. main bronchus followed by Lt. main bronchus.
The commonest types of inhaled FBs were organic in 56% of the cases in the form of seeds and nuts while inorganic FBs found in 33.33% of the cases where scarf pin were the commonest type.
It was noted that 71.43% of organic FBs inhalation were presented late (after 3weeks) while 68% of inorganic FBs were presented early (within 3 weeks) with significant statistical difference (p=0.004).
The commonest complications in the tracheobronchial tree resulting from FBI were: bleeding followed by granulation tissue then purulent secretion and airway stenosis. It was noticed that these complications were more among late cases than early cases with high significant statistical difference (p <0.001) especially with granulation tissue that recorded more in patients younger than 3 years old with high significant statistical difference (p<0.001).
It also noted that these complicated IFB were associated with longer procedure time (>30 min) especially if associated with granulation tissue, bleeding and purulence with high significant statistical difference (p<0.001), while with significant statistical difference if associated with airway stenosis (P=0.003).
Organic FBs extraction lasted more than 30 minutes while inorganic FBs extraction lasted less than 30 minutes with high significant statistical difference (p<0.001).
It was also recorded that organic inhaled FBs were associated with complications more than inorganic type with high significant statistical difference (p<0.001).
The commonest procedure related complications in this study were: bleeding (49%), hypoxia (45.33%). Both complications showed high significant statistical difference (p<0.001).
The present study illustrated that organic FBs were more common in male patients younger than 3 years old and who were associated with risk factor with significant statistical difference.
As regards medications received during procedure, it was found that all patient received systemic steroid (100%), while local steroids was given in (37.33%) and local antibiotics was given in (37.33%). Whereas medications given post procedure was short courses of antibiotics in (60%), short courses of steroids in (54.67%), mucolytics in (38.67%) and bronchodilator in (24%).
59 patients (78.67%) followed up while 16 patients (21.33%) missed their followed up.
Among the 59 patients who followed up; it was illustrated that (42.67%) complied while (36%) stopped and (13.33%) were referred to other specialties.
The follow up duration for <1 month was more optimal for most of the patients than duration > 1 month as regard gender, age and type of inhaled FB with significant statistical difference (P= 0.037, 0.043, 0.015 respectively).
Clinical assessment of the patients during follow-up; it was found that, (73%) of the patients showed complete improvement while (5.3%) showed partial improvement.
Radiological evaluation of the patients during follow up; revealed that 37 cases (78.7%) showed complete resolution within one month with high statistically significant difference whereas 7 cases had persistent finding in their follow up after one month with high significant statistical difference (P<0.001) and (1.3%) showed new finding in the form of bronchiectasis while in (6.67%) chest x-ray were not done, because the patients refused.
Rebronchoscopy during follow up; it was found that (57.33%) of the patient did not need rebronchoscopy during their follow-up, (13.3%) needed and the rebronchoscopy were performed for them while (8%) were indicated but they refused.
However all the patients who need bronchoscopic follow up once performed <1 month recording highly statistically significant different (p <0.001), otherwise there is no statistically significant difference.
The commonest bronchoscopical findings during follow up were: airway stenosis (n=4 and 5.33%), granulation tissue (n=3 and 4%) and purulent secretions (n=2 and 2.67%) while 4 patients (5.33%) showed marked improvement of the previous findings.
As regards impact of time interval duration on follow up duration, it was illustrated that 22/39 cases (56.4%) who followed up for < 1month were presented early, while 17/20 cases who followed up for > 1 month were presented late significant statistical difference (P= 0.002).
Moreover, the patients with complicated IFB were more adherent to follow-up weather < or > 1 month showed statistical significant difference (P=0.009).