From the Guidelines
Rigid bronchoscopy is the preferred method for foreign body (FB) removal from the airway, as it provides better airway control, superior suction capability, and allows for ventilation during the procedure while maintaining a larger working channel for instrumentation. The procedure should be performed under general anesthesia with the patient spontaneously breathing when possible. Prior to the procedure, a thorough history, physical examination, and imaging studies (chest X-ray, CT scan if needed) should be obtained 1. The bronchoscopy team should include an experienced bronchoscopist, anesthesiologist, and assistants. Equipment preparation is crucial, including having various sizes of rigid bronchoscopes, optical forceps, grasping forceps, suction devices, and a backup flexible bronchoscope.
Key Considerations
- The primary indications for rigid bronchoscopy include management of massive haemoptysis, treatment of tracheobronchial stenosis, foreign body removal, tumour resection, and deep bronchial-wall biopsy 1.
- Contraindications specific to rigid bronchoscopy include an unstable cervical spine, severe maxillofacial trauma or deformity, or obstructing oral or laryngeal disease 1.
- A study demonstrated that fewer treatment sessions were required with rigid vs flexible bronchoscopy (1 vs 2 sessions, P < 0.001) 1.
Procedure Details
During the procedure, the rigid bronchoscope is inserted through the mouth into the trachea, allowing direct visualization of the airway. Once the foreign body is located, appropriate forceps are used to grasp and remove it along with the bronchoscope in one movement. For challenging cases, a combination of rigid and flexible bronchoscopy may be necessary. Post-procedure care includes monitoring for complications such as laryngeal edema, bronchospasm, or pneumothorax. Patients typically require observation for 24 hours, with steroids and antibiotics administered if significant inflammation or infection is present.
Outcome Prioritization
The choice of rigid bronchoscopy for foreign body removal prioritizes morbidity, mortality, and quality of life by minimizing the risk of complications and ensuring effective removal of the foreign body, as supported by the most recent and highest quality study 1.
From the Research
Guidelines for Rigid Bronchoscope for FB Removal
- The use of rigid bronchoscope for foreign body (FB) removal is a common practice, especially in cases where flexible bronchoscopy is not feasible 2, 3.
- Rigid bronchoscopic intervention is effective in cases of risk of foreign body encroachment into the bronchial mucosa or granulation tissue development 3.
- The procedure can be performed under general anesthesia, with the use of an endobronchial blocker and rigid bronchoscopy 2.
- High-frequency jet ventilation (HFJV) can be used to preserve the patient's spontaneous respiration during the procedure 2.
- Virtual reality-aided presurgical planning can be useful in simulating the clinical situation and planning the removal of the foreign body 3.
- The choice of anesthesia is crucial, with propofol and sevoflurane with spontaneous ventilation being a suitable option for children 4.
- Adverse effects such as intraoperative coughing, breath holding, body movement, bronchospasm, and laryngospasm can occur, and the choice of anesthesia can affect the frequency of these events 4.
- Rigid bronchoscopy can be used in conjunction with other modalities, such as forceps, loop, basket, knife, electromagnet, and cryotherapy, to remove foreign bodies in adults 5.
- Flexible bronchoscopy with multiple modalities can be an effective alternative to rigid bronchoscopy for foreign body removal in adults, with a high success rate (90%) 5.