Prevalence of flexible bronchoscopic removal of foreign bodies in the advanced elderly

Section of Pulmonary, Critical Care, Environmental, and Sleep Medicine, Carilion Clinic, Roanoke, VA 24014, USA.
Age and Ageing (Impact Factor: 3.64). 04/2009; 38(4):396-400. DOI: 10.1093/ageing/afp044
Source: PubMed


to define the likelihood and establish the overall safety and effectiveness of flexible bronchoscopy in the removal of foreign bodies in the advanced elderly compared to those younger.
a retrospective case-control analysis.
tertiary care academic hospital. Population: 7,089 adults (age >18 years), including 949 (15%) advanced elderly (age >75 years), who underwent flexible bronchoscopy between January 1995 and June 2007.
in those patients with foreign body aspiration (FBA) (n = 20), a comparison of multiple clinical characteristics based on defined age groups (group 1, age <75 years and group 2, age >75 years) was performed.
FBA requiring bronchoscopic removal was greater than three and a half times more likely in patients aged >75 years compared to those younger (OR 3.78, CI 1.4-10: P <0.05). Flexible bronchoscopy was 87.5% effective in the removal of foreign bodies in the advanced elderly and associated with no increase in adverse events.
bronchoscopic removal of foreign bodies is more likely in the advanced elderly when compared to those younger. This implies that this population may be most at risk. Flexible bronchoscopy is a safe and effective initial diagnostic and therapeutic approach in this age group.

Download full-text


Available from: Sonal Singh, Dec 24, 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Foreign body aspiration is an uncommon entity in adults. Herein, we describe our experience with flexible bronchoscopy in the removal of tracheobronchial foreign bodies in adults. We also conducted a systematic review of the literature on the topic of foreign body inhalation in adults managed with flexible bronchoscopy. The bronchoscopy database (from 1979 to 2014) was reviewed for subjects >12 y of age with a history of foreign body aspiration managed with flexible bronchoscopy. Demographic, clinical, and bronchoscopy data were collected and analyzed. PubMed was reviewed for studies describing the use of flexible bronchoscopy for foreign body extraction in adults. During the study period, a total of 25,998 flexible bronchoscopies were performed. Of these, 65 subjects (mean age of 32.8 y, 49 males) were identified who had undergone bronchoscopy for foreign body aspiration. Nonresolving pneumonia (30.6%), direct foreign body visualization (24.6%), and segmental collapse (18.4%) were the most common radiological abnormalities. Foreign bodies were identified in 49 cases during bronchoscopy and successfully removed in 45 (91.8%) subjects with no major complications. Metallic (41%) and organic (25.6%) foreign bodies were the most common. Shark-tooth (44.9%) and alligator (32.6%) were the most commonly used forceps in retrieving the foreign bodies. The systematic review yielded 18 studies (1,554 subjects with foreign body inhalation). In adults, the proportion of flexible bronchoscopy (6 studies, 354/159,074 procedures) performed for the indication of foreign bodies among the total flexible bronchoscopies was 0.24% (95% CI 0.18-0.31). The overall success of flexible bronchoscopy (18 studies, 1,185 subjects) for foreign body extraction was 89.6% (95% CI 86.1-93.2). Foreign body aspiration is a rare indication for flexible bronchoscopy in adults. Flexible bronchoscopy has a high success rate in removal of inhaled foreign body and can be considered the preferred initial procedure for management of airway foreign bodies in adults. Copyright © 2015 by Daedalus Enterprises.
    No preview · Article · May 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Flexible bronchoscopy (FB) is a commonly performed procedure for diagnostic and therapeutic interventions of pulmonary disorders. Due to high prevalence of lung diseases especially lung cancer in the aging population, there is an increasing demand for FB in elderly patients. Flexible bronchoscopy is a well-tolerated procedure with low complication rate and mortality while providing valuable diagnostic and staging information. However, due to age-related decline in cardiopulmonary reserves and frequent presence of co-morbid conditions, procedural safety is the most critical issue in any elderly patient undergoing FB. A thorough understanding of these cardiopulmonary limitations and a careful assessment of medical issues, functional status and social support are essential in every elderly patient before performing bronchoscopy. Several studies have shown that age has no major effect on procedure-related complications or tolerance to bronchoscopy even with recent addition of increasingly complex and longer procedures. Advanced age by itself is not a contraindication to bronchoscopy.
    No preview · Article · Jun 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aspiration of foreign bodies is more common in the extremes of age. The increased risk in the elderly patient results from multiple factors including poor dentition, altered sensorium, poor coordination of deglutition mechanisms, and significant comorbidities. Unfortunately, non-specific symptoms contributing to a delay in diagnosis often result in complicated management issues. We describe the epidemiology, clinical presentation, and treatment options in the elderly patient. A high index of suspicion and prompt multidisciplinary approach maximize the likelihood of a positive outcome. An assessment of the technological and human capital necessary to address this life-threatening condition will likely guide the decision to treat or transfer the patient to the appropriate facility. Flexible and rigid bronchoscopies are the cornerstones of the diagnosis and treatment and should always be offered to the patient, regardless of the overall clinical condition. The probability of successful foreign body removal in trained hands is very high.
    No preview · Article · Jun 2015
Show more