Management of suspected tracheobronchial foreign body in infants

The diagnosis and early extraction of a respiratory foreign body (FB) in a child requires a rapid bronchoscopy. Thus, the possibility of a foreign bod y requires an endoscopy even in the absence of clinical or radiological sig ns. While the sensititivity of "the foreign or radiological signs" is impor tant (79- 85%) its specificity is low (21-46%) which results in numerous en doscopies which do not show FB. This justifies the promotion of flexible fi broscopy, under a simple local anaesthesia of the upper airways and some se dation, each time that the foreign body is not obvious. That is when there is an absence of a radio-opaque foreign body (2-20% of cases) or an absence of associated unilateral diminution in breath sound or ipselateral obstruc tive emphysema (a positive predicted value of 94%, 95% confidence interval: 71-100%). The complications of flexible fibroscopy are rare but still just ify its performance in an environment where there is resuscitation equipmen t and the possibility of rapidly performing a rigid bronchoscopy. Rigid bro nchoscopy, which requires a general anaesthesia, remains the best technique to cases of respiratory distress where there is a fear of a foreign body i n the trachea. The extraction of the CE by flexible fibroscopy under genera l anaesthesia has been reported in children but it is more difficult and mo re risky.