Removal of inhaled foreign bodies--middle of the night or the next morning?

OBJECTIVE

Foreign body inhalation is a potentially life-threatening emergency and is the commonest cause of accidental death in children under one year old. There is varying opinion regarding the urgency for removal of inhaled foreign bodies; most centres in the United Kingdom will take the patient to theatre as soon as can be arranged, regardless of the time of day. At Great Ormond Street Hospital for children it has been standard practice to perform rigid bronchoscopy and removal of an inhaled foreign body on the next available daytime operating list, providing the patient is clinically stable, even if this incurs a delay until the following day. We aimed to identify if any additional morbidity resulted from delaying removal of the foreign body.

METHODS

Retrospective case note review of all cases of foreign body inhalation seen at our institution over an 11-year period between July 1996 and July 2007.

RESULTS

165 patients were referred to our institution with a suspected inhaled foreign body in the study period. 14 patients were managed conservatively due to low clinical suspicion and 57 patients underwent a negative bronchoscopy: these groups were excluded from our analysis. Of the remaining 94 patients, only 7 were taken to theatre outside a scheduled daytime operating list. All of these patients had signs of severe respiratory distress and were operated upon within 4h of their arrival. Of the remaining patients, 41 were taken to theatre on the day of presentation and 46 on the day after presentation; all within normal daytime working hours. No additional post-operative morbidity was identified as a result of our policy to delay bronchoscopy until the next available daytime operating list.

CONCLUSIONS

It is our perception that delaying removal of suspected inhaled foreign bodies to allow optimal circumstances for manipulation of the paediatric airway is a safe practice at our institution. We have not identified any adverse outcomes related to delaying bronchoscopy to the next available daytime operating list in the clinically stable patient. This remains our preferred method of practice.