Endoscopic management of foreign bodies in the tracheobronchial tree: predictive factors for complications

We reviewed the records of 504 patients admitted to the American University of Beirut Medical Center during a 10-year period for treatment of aspiration of a foreign body into the tracheobronchial tree. All underwent rigid fiberoptic bronchoscopy for removal of the foreign body. Complications occurred in 42 patients (8%) and were classified as intraoperative (7 patients), postoperative (25 patients), and failure to retrieve the foreign body by bronchoscopy (9 patients). These complications included respiratory distress necessitating tracheotomy and/or assisted ventilation, bronchial pneumonia, pneumothorax, bradycardia, and cardiac arrest. Variables that were examined were the age and sex of the patient, history of multiple previous bronchoscopies, delay in diagnosis and/or treatment, duration of the procedure, type and location of the foreign body, and use of corticosteroids during surgery. The most important variables that were of value in predicting the occurrence of complications were the history of previous bronchoscopy, the duration of the procedure, and the type of foreign body. Age, sex, delay in diagnosis and treatment, and intraoperative use of corticosteroids, while important, had no predictive value. Detailed results with guidelines for prevention and management are presented.