Respircase Cilt: 9 - Sayı: 3 Yıl: 2020

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RESPIRATORY CASE REPORTSRespir Case Rep 2020;9(1):4-7 DOI: 10.5505/respircase.2020.09226OLGU SUNUMUCASE REPORTApproach to Foreign Body Aspiration in anInfant Using a CryoprobeKriyoprob Kullanarak bir Bebekte Yabancı Cisim Aspirasyonuna YaklaşımMohammad Ashkan MoslehiAbstractForeign body (FB) aspiration is a true medical emergencythat occurs due to airway obstruction in whichimmediate removal is crucial. Rigid bronchoscopy isthe preferred method for the removal of foreign bodieslodged in the airways, however studies have foundthat a flexible bronchoscopy can achieve greatersuccess rates. Recently, although there have beenreports of a cryoprobe being used for the removal ofFBs in adults, in pediatrics, and especially in infancy,there is little experience about its use, in that tracheobronchialFB aspiration is an infrequently encounteredevent among neonates and in early infancy.This report highlights the efficacy of using a cryoprobefor a flexible bronchoscopy for the managementof a retained FB in a young infant.Key words: Foreign body aspiration, Bronchoscopictreatment, Cryotherapy, Infant.ÖzetYabancı cisim aspirasyonu, hava yolu obstrüksiyonunaneden olduğu için acil bir tıbbi durumdur ve bunedenle, bu tür durumlarda yabancı cismin hemençıkarılması çok önemlidir. Rijit bronkoskopi, yabancıcisimlerin çıkarılmasında ilk tercih edilen yöntemdir,ancak bazı çalışmalar flexible bronkoskopinin deyüksek başarı oranı sağlayabildiğini göstermiştir. Sonzamanlarda, erişkinlerde, yabancı cisimlerin çıkarılmasında,kriyoprobun kullanımıyla ilgili bazı bildirimlervardır. Fakat pediatrik grupta, özellikle yeni doğanve infant dönemde, nadiren karşılaşılan bir durumolduğu için kullanımı konusunda çok az deneyimvardır. Biz de infant dönemde yabancı cisim aspirasyonuolan olgumuzda, flexible bronkoskopi ile kriyoprobkullanmanın da etkinliğini vurgulamak ve bukonudaki deneyimlere katkıda bulunmak için olgumuzusunmayı amaçladık.Anahtar Sözcükler: Yabancı cisim aspirasyonu, Bronkoskopiktedavi, Kriyoretapi, Infant.Pediatric Interventional Pulmonology Department, Shiraz Universityof Medical Sciences, Shiraz, IranŞiraz Tıp Bilimleri Üniversitesi, Çocuk Cerrahisi PulmonolojiAnabilim Dalı Başkanı, Şiraz, İranSubmitted (Başvuru tarihi): 11.09.2019 Accepted (Kabul tarihi): 29.11.2019Correspondence (İletişim): Mohammad Ashkan Moslehi, Pediatric Interventional Pulmonology Department, Shiraz University ofMedical Sciences, Shiraz, Irane-mail: ashkanmoslehi@gmail.com4
Respiratory Case ReportsForeign body aspiration in childhood is a common andpotentially serious problem. A thorough history and aphysical examination are of paramount importance in theevaluation of a child with a suspected FB, as this canfrequently lead to a diagnosis without the need for furtherdiagnostic workups or imaging. The majority of FB aspirationsare observed in children aged 4 years and younger(1). Choking, coughing, stridor, wheezing and vocalchanges are the most common indications that a mayhave aspirated a foreign body. Treatment depends on thetime of aspiration, and the location, type and size of theforeign body. A bronchoscopy may be needed to removethe item. There are some clear advantages to use of theRB for the removal of a tracheobronchial FB, howevermodern endoscopic equipment is available in varioussizes and configurations to suit the patient’s age and size.Furthermore, both flexible and rigid endoscopic equipmentare currently available.CASEA challenging case of 7-month-old female infant waspresented with progressively increasing stridor, coughing,cyanotic spells and respiratory distress over the past 2weeks. The parents provided a history, stating that theproblem had started while the patient was playing withher elder sister when she started showing the signs ofchoking and coughing, and became cyanotic and breathless.AN examination revealed severe respiratory distress,inspiratory stridor, localized wheeze and reduced air entryon the left side. Oxygen saturation was variable, butmostly around 80–85% in room air. A chest X-ray showeda left side whiteout lung with collapse due to a severeobstruction on the left side with a mediastinal shift (Figure1). This case was rare in that it is unusual for an FB tolodge distally in the left bronchus, especially in such asmall infant. An urgent RB was performed in the operationroom, but the surgeon was unable to extract the FBas it was lodged distally, out of the range of a rigid bronchoscope,and was embedded within granulation tissue.Moreover, the patient’s condition became worse duringthe rigid bronchoscopy procedure, so the infant was intubatedand transferred to the PICU. The surgeon askedour department to manage the patient, and after talkingto the parents, they gave us consent to make a furtherinvestigation with a fiberoptic bronchoscopy, and if possible,to remove the FB using the Cryoprobe. The patientwas transferred to our bronchoscopy suite and underwentour sedation protocol, in which atropine was administeredto decrease trachea-bronchial secretions, an intermittentintravenous injection of Propofol for light sedation,and strict dose monitoring to maintaining the patient’sspontaneous breathing. As a primary investigation, first, a2.8 mm fiberoptic bronchoscope was passed through theETT. The bronchoscopy confirmed the presence of an FBin the left main bronchus with inspissated thick mucosalsecretions and some granulation tissue. To maintain theoxygen level, the long nasal prongs were placed in thehypopharynx above the vocal cords. After applying suction,and applying an epinephrine solution, the patientwas extubated, as the author had to use a 4.3 bronchoscopewith a 2 mm working channel for the passage of athin 2 mm cryoprobe (ERBE Elektromedizin GmbH, Germany).Thebronchoscope was placed in the best possibleposition to access the object. Using the cryoprobe, freezingwas applied to the head of the FB for 5 seconds. Aftercreating an ice ball formation, the object was disengagedfrom the mucosa and was moved proximally into thetrachea. In the following stage, through continuous freezing(without releasing the foot pedal), the FB was attachedtightly to the tip of the cryoprobe and was fullyremoved en bloc, along with the flexible bronchoscope.The FB was a nut particle (Figure 2). After cryoextraction,the bronchoscope was again navigated into the involvedairway to look for any complications and to remove thesecretions. Only thick mucosal secretions that had beentrapped behind the obliterated bronchus were noted, andwere removed by suction through the working channel.Figure 1: Chest X-ray showing the left side whiteout lungCilt - Vol. 9 Sayı - No. 1 5
Page 3 and 4: RESPIRATORY CASE REPORTSRespir Case
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Page 9 and 10: Respiratory Case ReportsAUTHOR CONT
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Page 15 and 16: Respiratory Case ReportsGranülomat
Page 17 and 18: Respiratory Case Reportspolyangiiti
Page 19 and 20: Respiratory Case ReportsChest wall
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Page 25 and 26: Respiratory Case Reportsmass lesion
Page 29 and 30: Göğüs Duvarı Tümörünü Takli
Page 33 and 34: Crohn Hastalığına Bağlı Organi
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Page 37 and 38: Respiratory Case ReportsImmunoglobu
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Respircase Cilt: 9 - Sayı: 3 Yıl: 2020

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