Foreign Body Aspiration Follow-up

Updated: Dec 31, 2015
  • Author: Martin E Warshawsky, MD, FACP, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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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.

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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. Oral pierced jewelry should be removed prior to general anesthesia, emergency airway management, or other such manipulation of the oral pharynx because of the risk of dislodgement and aspiration. [14]

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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
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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.

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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 eMedicineHealth's Digestive Disorders Center. Also, see eMedicineHealth's patient education articles Choking, Swallowed Object, and Bronchoscopy.

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