eMedicine Specialties > Pulmonology > Aspiration and Atelectasis

Foreign Body Aspiration: Follow-up

Author: Martin E Warshawsky, MD, FACP, FCCP, Director of Respiratory Intensive Care Unit, Elmhurst Hospital Center; Clinical Assistant Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Mount Sinai School of Medicine
Contributor Information and Disclosures

Updated: Jun 3, 2008

Follow-up

Further Inpatient Care

If the foreign body is quickly and easily removed before mucosal alterations, atelectasis, emphysema, or suppurative complications set in and if the patient is asymptomatic, no further inpatient care should be necessary. Observing patients for 1-2 days postextraction may be appropriate, in case complications from impaction or extraction arise. Noncardiogenic reexpansion pulmonary edema, airway inflammation, hemoptysis, pneumothorax, tracheoesophageal fistula, pneumonia, atelectasis, fever, or ventilatory failure may require continued hospitalization, including ICU monitoring, intubation, mechanical ventilation, repeated bronchoscopic procedures (eg, directed suctioning of inspissated pus, laser therapy of bleeding, obstructing granulation tissue or polyps), antibiotics, corticosteroids, bronchodilators, or chest physical therapy.

Deterrence/Prevention

Pay attention to the size and texture of foods and objects available to children and adults with impaired mentation or ability to protect the airway (eg, impaired chewing, swallowing, coughing). Removal of appliances prior to manipulation of the teeth or airway is essential. Note the condition of medical equipment at the beginning and end of procedures involving the pharynx, larynx, respiratory tract, or digestive tract. Sedatives and topical anesthetics increase the risk for aspiration; therefore, use them sparingly.

Complications

The severity of the complications of foreign body aspiration depends on the size, shape, composition, location, and orientation of the aspirated object. The following complications may ensue:  

  • Cough
  • Dyspnea
  • Wheeze
  • Stridor
  • Hemoptysis
  • Asphyxia
  • Laryngeal edema
  • Pneumothorax
  • Pneumomediastinum
  • Tracheobronchial rupture
  • Cardiac arrest

Delay in treatment can result in the following conditions: 

  • Obstructive emphysema
  • Atelectasis
  • Tracheoesophageal fistula
  • Bronchial stricture
  • Pneumonia
  • Persistent cough
  • Hemoptysis
  • Polyp formation
  • Localized bronchiectasis
  • Chronic postobstructive pneumonia
  • Lung abscess
  • Bronchopleural fistula
  • Decreased lung perfusion

Chronic complications may be due to the foreign body itself or to trauma induced during attempts to remove the object. The complication rate increases if extraction is delayed. Noncardiogenic pulmonary edema may develop with reexpansion of an atelectatic lung. Bleeding from granulation tissue is usually mild but can be massive. Relief of long-standing bronchial obstruction can result in soiling of the bronchial tree with purulent secretions. The following unusual complications may ensue:  

  • Pulmonary hemorrhage
  • Laryngeal stenosis
  • Tracheoesophageal fistula
  • Perforation
  • Mediastinitis
  • Impaction of parts of instruments
  • Distal impaction of foreign body fragments

Prognosis

Almost all foreign bodies can be removed from the tracheobronchial tree using bronchoscopy. The complication rate increases as the time to the diagnosis and extraction of the object exceeds 24 hours. Data are lacking regarding the long-term consequences of long-present foreign bodies that cannot be extracted bronchoscopically and are incidentally found on chest radiographs in completely asymptomatic patients. Periodically monitor these patients for signs of airway obstruction, perforation, suppurative complications, or the development of scar carcinoma.

Patient Education

Educate patients, parents, and other caregivers about providing foods of appropriate size and texture, based on the patient's ability to chew and swallow. Recognize that a depressed level of consciousness and the use of sedatives increase the risk of foreign body aspiration. Train caregivers in methods of clearing the airway (eg, Heimlich maneuver, finger sweep).

For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center and Procedures Center. Also, see eMedicine's patient education articles Choking, Swallowed Object, and Bronchoscopy.

Miscellaneous

Medicolegal Pitfalls

  • Failure to ensure that all of the foreign body has been extracted

Special Concerns

Pay attention to the size and texture of foods and objects available to children and adults with impaired mentation or ability to protect the airway (eg, inadequate dentition, impaired chewing, impaired swallow, cough reflexes).

 


More on Foreign Body Aspiration

Overview: Foreign Body Aspiration
Differential Diagnoses & Workup: Foreign Body Aspiration
Treatment & Medication: Foreign Body Aspiration
Follow-up: Foreign Body Aspiration
References
[ CLOSE WINDOW ]

References

  1. Cleveland RH. Symmetry of bronchial angles in children. Radiology. Oct 1979;133(1):89-93. [Medline].

  2. Debeljak A, Sorli J, Music E, Kecelj P. Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974-1998. Eur Respir J. Oct 1999;14(4):792-5. [Medline].

  3. Mittleman RE, Wetli CV. The fatal cafe coronary. Foreign-body airway obstruction. JAMA. Mar 5 1982;247(9):1285-8. [Medline].

  4. National Safety Council, Research and Statistics Department. Injury Facts 2008 Edition. Itasca, Ill: National Safety Council; 2008:8, 14-15.

  5. Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med. Apr 15 1990;112(8):604-9. [Medline].

  6. Capitanio MA, Kirkpatrick JA. The lateral decubitus film. An aid in determining air-trapping in children. Radiology. May 1972;103(2):460-2. [Medline].

  7. Berger PE, Kuhn JP, Kuhns LR. Computed tomography and the occult tracheobronchial foreign body. Radiology. Jan 1980;134(1):133-5. [Medline].

  8. Adaletli I, Kurugoglu S, Ulus S, Ozer H, Elicevik M, Kantarci F, et al. Utilization of low-dose multidetector CT and virtual bronchoscopy in children with suspected foreign body aspiration. Pediatr Radiol. Jan 2007;37(1):33-40. [Medline].

  9. Haliloglu M, Ciftci AO, Oto A, Gumus B, Tanyel FC, Senocak ME, et al. CT virtual bronchoscopy in the evaluation of children with suspected foreign body aspiration. Eur J Radiol. Nov 2003;48(2):188-92. [Medline].

  10. Joshi AR, Agrawal NV, Zambre GY, Khandelwal AR. Role of MSCT chest and virtual bronochoscopy in suspected foreign body inhalation. Bombay Hosp J [serial online]. Available at www.bhj.org/journal/2004_4505_jan/case_toc.htm.

  11. Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest. May 1999;115(5):1357-62. [Medline].

  12. Chen CH, Lai CL, Tsai TT, Lee YC, Perng RP. Foreign body aspiration into the lower airway in Chinese adults. Chest. Jul 1997;112(1):129-33. [Medline].

  13. Fieselmann JF, Zavala DC, Keim LW. Removal of foreign bodies (two teeth) by fiberoptic bronchoscopy. Chest. Aug 1977;72(2):241-3. [Medline].

  14. Fraser RG, Pare JA, Pare PD. Pulmonary disease caused by aspiration of solid foreign material and liquids. In: Diagnosis of Diseases of the Chest. 3rd ed. Philadelphia, Pa: WB Saunders; 1990:2382-416.

  15. Irwin RS, Ashba JK, Braman SS, Lee HY, Corrao WM. Food asphyxiation in hospitalized patients. JAMA. Jun 20 1977;237(25):2744-5. [Medline].

  16. Martinot A, Closset M, Marquette CH, Hue V, Deschildre A, Ramon P, et al. Indications for flexible versus rigid bronchoscopy in children with suspected foreign-body aspiration. Am J Respir Crit Care Med. May 1997;155(5):1676-9. [Medline].

  17. McGuirt WF, Holmes KD, Feehs R, Browne JD. Tracheobronchial foreign bodies. Laryngoscope. Jun 1988;98(6 Pt 1):615-8. [Medline].

  18. Prakash UB, Cortese DA. Tracheobronchial foreign bodies. In: Bronchoscopy: A Text Atlas. Philadelphia, Pa: Lippincott-Raven; 1997:253-77.

  19. Rudavsky AZ, Leonidas JC, Abramson AL. Lung scanning for the detection of endobronchial foreign bodies in infants and children. Clinical and experimental studies. Radiology. Sep 1973;108(3):629-33. [Medline].

  20. Tietjen PA, Kaner RJ, Quinn CE. Aspiration emergencies. Clin Chest Med. Mar 1994;15(1):117-35. [Medline].

  21. Warshawsky ME, Shanies HM, Dharawat M, Grochowski S. Endotracheal intubation-induced upper airway obstruction. Heart Lung. Jan-Feb 1996;25(1):69-71. [Medline].

  22. Weissberg D, Schwartz I. Foreign bodies in the tracheobronchial tree. Chest. May 1987;91(5):730-3. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

foreign body aspiration, aspirated objects, asphyxia, upper airway obstruction, café coronary, acute ventilatory failure, mediastinitis, tracheoesophageal fistula, bronchial obstruction, bronchiectasis, rigid bronchoscopy, flexible bronchoscopy, virtual bronchoscopy, bronchotomy, segmental resection

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Martin E Warshawsky, MD, FACP, FCCP, Director of Respiratory Intensive Care Unit, Elmhurst Hospital Center; Clinical Assistant Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Mount Sinai School of Medicine
Martin E Warshawsky, MD, FACP, FCCP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, and American Thoracic Society
Disclosure: Nothing to disclose.

Medical Editor

Stephen P Peters, MD, PhD, Professor, Department of Medicine, Wake Forest University
Stephen P Peters, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society, and Sigma Xi
Disclosure: See below for list of all activities None None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert S Crausman, MD, MMS, Chief Administrative Officer, Rhode Island Board of Medical Licensure and Discipline, Rhode Island Department of Health; Associate Professor, Department of Medicine, Brown University School of Medicine
Robert S Crausman, MD, MMS is a member of the following medical societies: American College of Chest Physicians and American College of Physicians
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.