The present study aimed to determine the effect of tracheobronchial aspiration on hospitalization outcomes and the factors influencing its occurrence.
This prospective descriptive study was conducted ...from January 2017 to December 2020 at GMC/DHQ-Teaching Hospital in Gujranwala, Pakistan. All consenting liver cirrhosis patients with hepatic encephalopathy > 12 years of age admitted at the study site were included. The patient's baseline characteristics and the hospitalization outcomes were noted in terms of death and discharge. The collected data was analyzed using SPSS version 22.0. The predictors of tracheobronchial aspiration were determined using Independent Sample T test and Chi-square test for quantitative and qualitative variables respectively. The p-values were taken statistically significant if < 0.05. A binary logistic regression analysis was performed to ascertain the effect of significant factors on the likelihood of tracheobronchial aspiration.
Among the total of 294 patients, 28.0% died during hospitalization. Death occurred significantly more in group of patients who had tracheobronchial aspiration (62.7% vs 12.0%, p<0.01). Increasing age was associated with increased chance of tracheobronchial aspiration (p<0.01). Male gender (49.6% vs 8.2%, p<0.01), patients whose hepatic encephalopathy was precipitated by upper GI bleed (59.7% vs 22.9%, p<0.01), and patients with comorbidities (p=0.02) were significantly prone to tracheobronchial aspiration.
Tracheobronchial aspiration is a significant predictor of inpatient mortality among patients with hepatic encephalopathy. Male gender, increasing age & upper GI bleed predict aspiration in hepatic encephalopathy patients.
(1) To study the presenting complaints or complaints suggestive of foreign bodies in the tracheobronchial tract. (2) To study the clinical findings. (3) To study the correlation between clinical and ...radiological findings. (4) To study different types of foreign bodies. (5) To study the complications caused by foreign bodies. A total of 115 patients presenting with foreign body aspiration in the tracheobronchial tract were included in the study. Patient characteristics, history, clinical, radiographic and bronchoscopic findings were noted. Foreign bodies in trachea and bronchus were removed by rigid bronchoscopy under general anaesthesia. Jackson rigid bronchoscope with a fibre optic light source and venturi technique anaesthesia was used. In the present study, foreign body aspiration was found to be maximum in the 1–3 year old age group. The average time lapse between aspiration of symptoms and presentation was found to be 1–3 days. Positive history was given in only 68% cases. Cough and breathlessness were the most common presenting symptoms. The commonest clinical signs were decreased chest movement and air entry on the affected side. Collapse of the affected side was the most common radiological finding. The commonest site of impaction was the right main bronchus. Majority of the foreign bodies were vegetative, peanut being the most common. The commonest complication following foreign body aspiration was atelectasis of the affected lung. Successful removal of foreign bodies was possible in all the patients. In paediatric respiratory compromise, the presence of unilateral diminished breath sounds, a pathological chest X-ray and a clinical triad of cough, choking and wheezing, is a powerful indicator of tracheobronchial foreign body aspiration. Since no single or combined variables can predict foreign body aspiration with full certainty, bronchoscopic exploration must be performed if tracheobronchial foreign body aspiration is suspected.
Department of Thoracic Surgery, Chest Disease Hospital, Kuwait
*Corresponding author. Al-Jabriah, P.O. Box 718, Postal Code: 46308, Kuwait. Tel.: +965 66600543; fax: +965 24741504. E-mail address : ...trinityq8{at}hotmail.com (N. Al-Sarraf).
Foreign body (FB) aspiration is commonly seen in children and less commonly in the elderly. However, due to some social and cultural factors, a distinct group of tracheobronchial FB aspiration is increasingly recognized. We sought to assess our experience with such entity. A retrospective review of all cases with veil pin tracheobronchial FB aspiration in a single center over a 13-year period was carried out. There were 35 cases of headscarf tracheobronchial FB aspiration. All were females with mean age of 14 years. All patients experienced coughing and all had positive chest radiography findings. Commonest anatomical location was right main bronchus (32%) followed by left main bronchus (23%). Tracheal pins occurred in 17%. Rigid bronchoscopy was used more often than flexible bronchoscopy (83% vs. 17%, respectively). Repeat bronchoscopy was required in two cases (6%). Thoracotomy was required in one patient (3%). There were no complications or hospital deaths. Headscarf pin aspiration is seen in middle-aged women who inappropriately place the pins between their lips prior to securing their veils. Bronchoscopy is the treatment modality of choice and surgery is rarely required. Preventative educational strategies should be implemented to reduce such an avoidable risk.
Key Words: Bronchoscopy; Foreign body; Tracheobronchial aspiration
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