A dual approach to tracheobronchial foreign bodies in children.

From 1974 to 1980, 57 consecutive cases of children with tracheobronchial foreign bodies were treated by a new protocol in which peripherally located foreign bodies were treated nonoperatively and centrally located foreign bodies were removed bronchoscopically. Bronchoscopic removal was ultimately successful in all of the 29 children in whom the foreign body was located in the trachea or mainstem bronchus. There were eight minor complications, and in three instances it was necessary to repeat the bronchoscopy for retained fragments. In the other 28 children the foreign body was located in the segmental or lobar bronchi, and initial treatment consisted of a program employing inhalation bronchodilators, pulmonary drainage, and thoracic percussion. Treatment was successful (foreign body coughed out) in 18 patients (64%). Of the other 10 children subsequent bronchoscopy was successful in eight and failed in two patients. Of the latter patients, one required bronchotomy, and the other coughed out the foreign body. There were no deaths, major complications, or permanent pulmonary damage in either treatment series.