Foreign body aspiration in children: our pediatric tertiary care experience.

PURPOSE: Inhalation of a foreign body is a real emergency in pediatric age and requires prompt diagnosis and treatment to reduce mortality. The objective of this study is to analyze clinical and radiological details, types, and localization of foreign bodies in patients conducted or to our hospital with suspected inhalation. METHODS: We conducted a retrospective analysis of all cases of foreign body inhalation admitted to our Pediatric Emergency Room between January 2009 and June 2022. RESULTS: 171 patients were included in the study. In 83 patients, the FB was detected. The mean age of presentation was 2.3 years (SD: ± 2). Cough (73%) and unilateral reduced breath sound (51%) were the most common clinical symptom and clinical sign. The most frequent localization was the right main bronchus (43%). The foreign bodies retrieved were vegetable (83%), of which peanut was the most common. Chest radiographs were normal in 25%. The mean duration of hospitalization was 5 days (± 2.9). Complications such as pneumothorax were seen in two cases. CONCLUSIONS: Foreign body inhalation represents a true pediatric emergency and still a challenge in clinical practice. The best way to manage it is an early diagnosis and removal by fully trained staff.

Foreign body aspiration score (FOBAS)-a prospectively validated algorithm for the management and prediction of foreign body aspiration in children.

Foreign body aspiration (FBA) is a common cause of pediatric morbidity, but a standardized protocol to guide decision-making about bronchoscopy is lacking. We aimed to validate a new Foreign body aspiration score (FOBAS) for the pediatric emergency department (ED). Patients aged 0-18 years referred to the ED for suspected FBA were prospectively enrolled. FOBAS was calculated according to clinical features of a choking episode, sudden cough, exposure to nuts, absence of fever and rhinitis, stridor, and unilateral auscultatory and radiological findings. FBA risk was evaluated based on the total score (low, 1-3; moderate, 4-6; high, 7-10). Low-risk children were discharged from the ED and followed clinically. Moderate-risk children were hospitalized and evaluated by a pediatric pulmonologist, and high-risk children were referred directly for therapeutic bronchoscopy. Among the 100 enrolled children (59% males; median age 20 [interquartile range 11-39] months), a foreign body was diagnosed in 1/49 (2%), 14/41 (34.1%), and 9/10 (90%) with low, moderate, and high FOBAS, respectively (P < .001). Logistic regression indicated a higher risk for FBA with higher scores. The odds ratio for each additional point was 2.75 (95% confidence interval 1.78-4.24), and FOBAS showed a high predictive value for FBA (area under the curve 0.89). FOBAS implementation significantly reduced the rate of negative bronchoscopies, from 67.4% annually during 2016-2019 to 50% in 2020 (P = .042). CONCLUSION: FOBAS reliably predicts FBA in cases of suspected FBA and improves management and in-hospital decision-making. WHAT IS KNOWN: • Foreign body aspiration is a major cause of pediatric morbidity and mortality. • Currently, there is no unified protocol for children referred to the emergency department for suspected FBA, therefore, a well-defined algorithm is needed to improve the decision-making process. WHAT IS NEW: • The pediatric Foreign body aspiration score (FOBAS) is a new, prospectively validated clinical score that shows high sensitivity and specificity for the presence of FBA in children. • FOBAS reduces unnecessary admissions and invasive procedures and leads to better clinical outcomes.

Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia.

BACKGROUND: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. RESEARCH QUESTION: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? STUDY DESIGN AND METHODS: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. RESULTS: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P = .021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P < .001) when compared with patients with severe CAP/AspRF+ and severe CAP/AspRF-, respectively. Most patients (>50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. INTERPRETATION: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.

Tracheobronchial foreign body aspiration in children: A retrospective single-center cross-sectional study.

Foreign body (FB) aspiration is a common and serious problem in childhood as it requires early recognition and treatment to avoid potentially lethal consequences. This study aimed to characterize the clinical and epidemiological features of airway FBs in a pediatric Chinese population.A retrospective review of medical records of children aged 0 to 14 years who attended with a diagnosis of FB aspiration the Shanghai Children's Hospital between January 2013 and December 2017 was carried out. Descriptive analysis was used to assess patient's demographics, clinical, radiographic, bronchoscopic findings, time to presentation, and characteristics of the FBs.Among the 200 patients included in the study, 92% were under 3 years of age, with a peak incidence of FB aspiration occurring between 1 and 2 years old. The male to female ratio was about 2.6:1. Twenty-three percent of the patients were admitted within 24 hours of the event, 40% within 1 week, 30% within 1 month, and 7% more than 1 month after aspiration. The most common presenting symptoms of laryngotracheal FBs were cough, dyspnea, and wheezing; those of bronchial FBs were cough, decreased air entry, and wheezing. Chest X-ray was normal in four-fifths of the children with laryngotracheal FBs, whereas most common abnormal X-ray findings in children with bronchial FBs were mediastinal shift, obstructive emphysema, and pneumonia. There was a trend that in children younger than 2 years FBs were more frequently found in the left bronchus, whereas in older children FBs were more frequently found in the right bronchus. Ninety-three percent of the removed FBs were organic materials such as food items and the most frequently aspirated FBs were peanuts. Flexible bronchoscopy was performed in 82.5% of the patients, while rigid bronchoscopy or direct laryngoscopy in 17.5% of the patients. Four patients were subjected to thoracic surgery and 1 died during rigid bronchoscopy due to acute respiratory failure.FBs is a frequent pathology among Chinese children. Tracheobronchial FBs should be strongly suspected in young children who have sudden onset of cough and wheezing episode, even when physical and radiographic evidence is absent.

Management of polyethylene glycol solution aspiration using bronchoscopic lavage in a dog.

Polyethylene glycol lavage solutions are used for colonic preparation in dogs and are considered relatively safe. Aspiration is an uncommon but potentially devastating complication of polyethylene glycol administration. Full recovery is possible and often rapid in people treated with bronchoalveolar lavage. A healthy 2-year-old male Beagle used in an endoscopy teaching laboratory aspirated a small amount of polyethylene glycol lavage solution. Although initially appearing unaffected, the dog quickly became hypoxemic. Bronchoscopy was used to lavage the lungs and aspirate tracheal/pulmonary fluid 5 times over the course of 45 minutes. The dog completely recovered. This report presents the successful treatment of polyethylene glycol aspiration in a dog. Although the seriousness of aspiration might not be immediately evident, bronchoscopy and lavage should be pursued because of the rapidly progressive nature of polyethylene glycol-induced pulmonary edema.

Foreign Body Aspiration in Infants and Older Children: A Comparative Study.

BACKGROUND: Foreign body aspiration (FBA) is a major cause of morbidity and mortality in children. It is a preventable event that predominates in preschool age. The signs and symptoms mimic respiratory diseases common in the same age-group. We compared FBA in infants to FBA in older children. METHODS: Retrospective analysis of all the cases of suspected FBA of children under the age of 18 years hospitalized at one medical center during 2002 to 2016. We analyzed the data according to age: up to 1 year (infants) and 1 to 18 years. RESULTS: One hundred seventy-five children with suspected FBA were admitted; of whom, 27 (15%) were infants and 148 (85%) were older children (age 1-18 years). For the 2 age groups, adults witnessed 85% and 73%, respectively, of the incidents (P = .4). In the neonate group, 48% presented with normal X-ray findings compared to only 20% in the older group; 15% of the older group had a positive chest X-ray for a foreign body, while none had such in the infants' group (P = .01). For the 2 age groups, the majority of the FBs found were from organic origin. About half of the patients were diagnosed and managed within 24 hours of the aspiration event. In 10%, repeated bronchoscopy was performed due to a retained FB remnant. In a multivariate analysis, signs and symptoms (P < .05), location of the FB (P < .001), and witnessed aspiration (P < .001) were independent prognostic factors for the length of hospitalization. CONCLUSION: Foreign body aspiration is not uncommon in young infants; the management is challenging due to small airways, the need to use smaller bronchoscopes, and the lack of working channel forces in pediatric bronchoscopes.

Algoritmo para el manejo de la aspiración pulmonar crónica en pediatría / Algorithm for the management of chronic pulmonary aspiration in pediatrics

La aspiración pulmonar es el pasaje de alimentos, reflujo gastroesofágico y/o saliva a la vía aérea de manera suficiente que ocasione síntomas respiratorios crónicos o recurrentes. Es una ausa importante de neumonía recurrente, enfermedad pulmonar progresiva, bronquiectasias e, incluso, muerte. La aspiración es intermitente y, con frecuencia, ocurre en niños con anomalías médicas subyacentes o síndromes que ocasionan síntomas respiratorios similares a la aspiración pulmonar crónica, por lo que, muchas veces, el diagnóstico de aspiración se demora hasta que haya una lesión pulmonar significativa. Se describen los métodos diagnósticos disponibles y sus limitaciones, y las opciones de tratamiento de la aspiración pulmonar crónica en la población pediátrica.

Pulmonary aspiration is the passage of food, gastroesophageal reflux and/or saliva to the airway in a manner sufficient to cause chronic or recurrent respiratory symptoms. It is an important cause of recurrent pneumonia, progressive lung disease, bronchiectasis and even death.Aspiration is intermittent and often occurs in children with underlying medical conditions or syndromes that cause respiratory symptoms similar to chronic pulmonary aspiration, so diagnosis of aspiration is often delayed until there is a significant lung injury. The available diagnostic methods and their limitations, and treatment options of chronic pulmonary aspiration in the pediatric population are described.

[Algorithm for the management of chronic pulmonary aspiration in pediatrics]. / Algoritmo para el manejo de la aspiración pulmonar crónica en pediatría.

Pulmonary aspiration is the passage of food, gastroesophageal reflux and/or saliva to the airway in a manner sufficient to cause chronic or recurrent respiratory symptoms. It is an important cause of recurrent pneumonia, progressive lung disease, bronchiectasis and even death. Aspiration is intermittent and often occurs in children with underlying medical conditions or syndromes that cause respiratory symptoms similar to chronic pulmonary aspiration, so diagnosis of aspiration is often delayed until there is a significant lung injury. The available diagnostic methods and their limitations, and treatment options of chronic pulmonary aspiration in the pediatric population are described.

La aspiración pulmonar es el pasaje de alimentos, reflujo gastroesofágico y/o saliva a la vía aérea de manera suficiente que ocasione síntomas respiratorios crónicos o recurrentes. Es una causa importante de neumonía recurrente, enfermedad pulmonar progresiva, bronquiectasias e, incluso, muerte. La aspiración es intermitente y, con frecuencia, ocurre en niños con anomalías médicas subyacentes o síndromes que ocasionan síntomas respiratorios similares a la aspiración pulmonar crónica, por lo que, muchas veces, el diagnóstico de aspiración se demora hasta que haya una lesión pulmonar significativa. Se describen los métodos diagnósticos disponibles y sus limitaciones, y las opciones de tratamiento de la aspiración pulmonar crónica en la población pediátrica.

[Analyses of diagnosis and treatment of foreign body aspiration in children with tracheobronchial variations].

Objective: To investigate the key issues in the diagnosis and treatment of foreign body aspiration in children with tracheobronchial variations. Methods: A retrospective study was performed for 11 pediatric patients who were treated in Department of Otorhinolaryngology and Head and Neck Surgery, Henan Province People's Hospital after a diagnosis of foreign body aspiration with tracheobronchial variations between January 2015 and December 2017. There were 7 males and 4 females among the 11 cases of foreign body aspiration with tracheobronchial variations, ranging between 9 months and 11 years of age. Results: Among 11 cases, the types of variationswere tracheal bronchus in 9 cases, bridging bronchus in 1 case and simple tracheal stenosis in 1 case. All of the pediatric patients were under general anesthesia, and the foreign bodies were removed by bronchoscopy successfully with no significant complications. Conclusions: The possibility of tracheobronchial variations should be considered in children with recurrent wheezing and poor efficacy of regular treatment before foreign body aspiration. Removal of foreign body via rigid bronchoscope under general anesthesia is a safe and effective treatment. These children are needed to combine the situation oftracheobronchial variations and the location of foreign bodies to guide the operation, and strengthened the perioperative treatment.

Neuromuscular electrical stimulation improves feeding and aspiration status in medically complex children undergoing feeding therapy.

OBJECTIVES: Neuromuscular electrical stimulation (NMES) therapy in the head and neck has been effectively used to rehabilitate swallowing in adult patients with acquired dysphagia. Limited data is available for the effectiveness of NMES in medically complex children with dysphagia and aspiration. This study intends to determine the efficacy of NMES as a therapeutic adjunct to improve aspiration and feeding status in medically complex children with severe dysphagia undergoing comprehensive speech and swallow therapy. STUDY DESIGN: Case series. SETTING: Tertiary children's hospital. SUBJECTS: and Methods: Medically complex children undergoing treatment for dysphagia using NMES during a three year period were included. Duration of treatment routinely ranged from 20 to 26 weeks. Demographic information, pre and post-NMES treatment aspiration status via modified barium swallow (MBS), and pre and post-NMES treatment feeding status were examined. RESULTS: 15 medically complex children underwent NMES as a component of their feeding therapy. The mean age was 2.51 ±â€¯3.20 years. Mean pre-treatment Functional Oral Intake Scale(FOIS) was 3.07 ±â€¯1.94. Following NMES, FOIS improved to 4.47 ±â€¯2.26 (p < 0.0001). Fourteen patients were evaluated with MBS prior to NMES. Pre-treatment aspiration and penetration were noted in 10 and 2 patients respectively. Two patients did not aspirate on pre-treatment MBS. Improvement was noted in 9 of 11 children with post-treatment MBS. CONCLUSION: NMES was safely completed in all children without complication. Improvement in aspiration status was seen in 83.3% of patients with pre- and post-treatment MBS. Feeding status as measured by textures was advanced in all patients with a significant improvement in FOIS. Future prospective studies are required to investigate the specific role in children with acquired and congenital dysphagia.

Deep interarytenoid notch in young children managed with systematic thickener wean and injection laryngoplasty.

OBJECTIVES: Deep interarytenoid notch (DIN) is a congenital variation of the larynx often associated with dysphagia and aspiration (DA) in young children. Feeding therapy with thickeners and surgical management with injection larygoplasty (IL) are used with various efficacies. Thickeners address the functional domain and IL addresses the anatomical domain of treatment. Our objective was to evaluate DIN patients managed with both interventions. METHODS: We conducted a retrospective pilot descriptive study of DIN patients with DA aged 1-3 years receiving thickeners and IL. Patients received a systematic weekly reduction of thickeners, referred to as the Thickener Weaning Protocol (TWP), based on clinical signs and symptoms of DA. The outcomes were assessed by the rate of thickener level reduction and DA-related sign/symptom frequency achieved at 6 months post-treatment. RESULTS: Thirteen patients with DIN associated DA were analyzed. The TWP was initiated within 2 months in 77% of patients, and within 4 months in 100% of patients. Thickener scores improved from an average of 5.76 (3/4 honey) to 2.15 (thin) (p = 0.001). DA-related signs/symptoms frequency improved from an average of 3.3 to 0.84 (p = 0.05). CONCLUSIONS: These findings suggest that treatment of DIN associated DA with a combination of thickeners and IL results in significant clinical improvements in young children.

Complications in children with percutaneous endoscopic gastrostomy (PEG) placement.

INTRODUCTION: The aim of this study was to analyze the complication rates and mortality in association with different operative techniques of percutaneous endoscopic gastrostomy (PEG), age, underlying diseases and other risk factors. Moreover, analysis of the indications of PEG insertion and the underlying comorbidities was also performed. METHODS: This study performs a literature analysis of PEG-related complications in children. Literature was searched on PubMed® (1994-2017) using terms "percutaneous endoscopic gastrostomy", "complications", "mortality" and "children". RESULTS: Eighteen articles with 4631 patients were analyzed. The mean age was 3 years (0-26 years). Operative techniques were: pull technique in 3507 (75.7%), 1 stage PEG insertion in 449 (9.7%), introducer technique in 435 (9.4%), image-guided technique in 195 (4.2%) and laparoscopic-assisted PEG in 45 (1.6%). Most frequent indications for PEG insertion were dysphagia (n = 859, 32.6%), failure to thrive (n = 723, 27.5%) and feeding difficulties (n = 459,17.4%). Minor complications developed in n1518 patients (33%), including granulation  (n = 478, 10.3%), local infection (n = 384, 8.3%) and leakage (n = 279, 6%). In 464 (10%) patients, major complications occurred; the most common were systemic infection (n = 163, 3.5%) and cellulitis (n = 47, 1%). Severe complication like perforation occurred in less than 0.3%. Patients with lethal outcomes (n = 7, 0.15%) had severe comorbidities; and the cause of mortality was sepsis in all cases. Prematurity or young age did not affect complication rate. Patients with ventriculoperitoneal (VP) shunt had higher risk of major complications. In high-risk patients, laparoscopic-assisted PEG insertion had less major and severe complication than traditional pull technique. CONCLUSIONS: PEG is a safe operative technique; although minor complications are relatively common and occur in up to 1/3 of patients, there is a fairly low rate of severe complications. Two-thirds of PEG patients have at least one comorbidity. Patients with VP shunt have higher risk of major complications. In high-risk patients, laparoscopic-assisted PEG is recommended.

[Management of suspected foreign body aspiration in children. 10-year experience in a single center]. / Sospecha de aspiración de cuerpos extraños en pacientes pediátricos. Nuestra experiencia en 10 años.

INTRODUCTION: Foreign body aspiration (FBA) is a potentially life-threatening event, and is the leading cause of death in children after road traffic injuries. If suspected, a prompt exploration of the airway should be performed. We present our experience in FBA treatment in the last 10 years. MATERIAL AND METHODS: A retrospective study of patients admitted in our center with suspected FBA between 2005 and 2015 was performed. Clinical history, physical findings, radiologic imaging, treatment and evolution were assessed. RESULTS: A total of 115 children (70 M/45 F) with a median age of 2 years old (8 months-13 years), presented with a clinical history of FBA. All of them suffered a choking event and the most frequent symptoms were persistent cough (88.3%) and respiratory distress (46.8%). Pathologic physical examination was registered in 75% and an abnormal chest X-ray was seen in 72%. Rigid bronchoscopy (RB) was performed in 100% based on compatible history, regardless of physical and radiologic exams. A foreign body was found during RB in 78 patients (68.1%) and the most frequent were seeds and nuts (63.4%), located mainly in the right bronchus (46.8%). If the criteria for RB had been based on a compatible history along with clinical findings and abnormal chest X-ray, 21 foreign bodies (26.9%) would have been missed, with the subsequent risk of sudden death. All the foreign bodies were removed with success, without any immediate complication during the procedure. CONCLUSION: FBA is a frequent accident among children. The history, clinical findings and imaging cannot always concur. In case of a positive history of FBA an examination of the tracheobronchial tree must be done.

OBJETIVOS: La aspiración de cuerpos extraños (ACE) es una urgencia pediátrica frecuente, descrita como segunda causa de muerte infantil tras los accidentes de tráfico. Presentamos nuestra experiencia en el tratamiento de la ACE en los últimos 10 años. MATERIAL Y METODOS: Estudio retrospectivo de pacientes atendidos por sospecha de ACE entre los años 2005-2015, describiendo historia clínica, sintomatología, pruebas de imagen, procedimiento y evolución. RESULTADOS: Un total de 115 pacientes (70 V/45 M), con una mediana de 2 años (8 meses-13 años), presentaron historia sugestiva de ACE. Los síntomas más frecuentes fueron: tos (88,3%) y dificultad respiratoria (46,8%). El 75% presentaban exploración física patológica y un 72% presentaban alteraciones en la radiografía de tórax. Se realizó broncoscopia rígida (BR) en el 100% de los pacientes con historia compatible, sin importar los resultados de la exploración física o las pruebas de imagen. En 78 pacientes (68,1%) se encontró un cuerpo extraño (CE) durante la BR, siendo los más frecuentes semillas y frutos secos (63,4%); localizándose sobre todo en el bronquio derecho (46,8%). Si el criterio para realizar una BR se hubiese basado en la historia compatible, junto con alteraciones en la exploración física y pruebas de imagen, 21 CE (26,9%) no habrían sido diagnosticados con el consiguiente riesgo de muerte. Todos los CE se extrajeron con éxito, sin ninguna complicación inmediata. CONCLUSIONES: La ACE es frecuente en la infancia. La historia y los hallazgos clínico-radiológicos pueden no concordar, por lo que ante historia sugestiva de ACE es recomendable una exploración de la vía aérea, dado el bajo riesgo que asocia.

Foreign body aspiration in a pregnant woman: successfully removed roasted chickpea.

Foreign body aspiration is a serious health problem in all age groups, and in pregnancy it may cause serious complications for the fetus as well as the pregnant woman. Here we present our case of a 36 years old 22 weeks pregnant woman, accidentally aspirating roasted chickpea upon laughing. She had the complaints of coughing and shortness of breath on admission, bronchoscopy was performed, and the roasted chickpea blocking the entrance of right lower lobe bronchus was removed without any complications. For foreign body aspiration in pregnancy, bronchoscopy is a rather safer procedure when performed by an experienced team.

Application of cystourethroscopy during tracheobronchial foreign body removal in children.

Objective This study aimed to describe preliminary experiences associated with removal of tracheobronchial foreign bodies (TFBs) by cystourethroscopy (CU). Methods We performed a retrospective analysis of 127 paediatric cases of TFB removal by CU at our centre from January 2009 to August 2016. Data that were extracted from the medical records included age, sex, location and nature of the TFBs, operation time, and complications. Results All TFBs were successfully removed by CU. The mean time of the procedure was 3.38 ± 2.86 minutes. A total of 102 (80.31%) patients had successful removal of TFBs by CU during the initial trial, 19 (14.96%) were successfully treated in the second trial, and six (4.72%) required a third trial. Otolaryngologists with 2, 5, and 7 years of professional CU training showed a mean TFB removal time of 3.38 ± 2.13, 3.40 ± 3.60, and 3.37 ± 2.86 minutes, respectively. In the operations, oxygen saturation fell below 90% at an average occurrence of 0.39 times, but no patients showed a decrease below 85%. Only one patient experienced laryngeal oedema after the procedure. Conclusion CU is a useful technique and minimizes complications and operational risks during removal of paediatric TFBs.

Causative treatment of acid aspiration induced acute lung injury - Recent trends from animal experiments and critical perspective.

Aspiration of low-pH gastric fluid leads to an initial pneumonitis, which may become complicated by subsequent pneumonia or acute respiratory distress syndrome. Current treatment is at best supportive, but there is growing experimental evidence on the significant contribution of both neutrophils and platelets in the development of this inflammatory pulmonary reaction, a condition that can be attenuated by several medicinal products. This review aims to summarize novel findings in experimental models on pathomechanisms after an acid-aspiration event. Given the clinical relevance, specific emphasis is put on deduced potential experimental therapeutic approaches, which make use of the characteristic alteration of microcirculation in the injured lung.

Fiberoptic bronchoscopic treatment of blood aspiration and use of sugammadex in a patient with epistaxis: A case report.

RATIONALE: In patients with oropharyngeal and nasopharyngeal bleeding, blood aspiration can make airway management difficult and lead to severe pulmonary complications. PATIENT CONCERNS: A 44-year-old male patient with recurrent epistaxis underwent surgery for hemostasis. The patient aspirated blood through the endotracheal tube when he hiccupped during the surgery. DIAGNOSIS: The patient was diagnosed with blood aspiration after intraoperative fiberoptic bronchoscopy revealed a blood clot and viscous mucus in the airways, but no sign of active bleeding. INTERVENTIONS: Tracheobronchial suctioning and irrigation with normal saline was performed through the bronchoscope to remove the aspirated blood clot. Prior to emergence from anesthesia, sugammadex was administered to induce complete neuromuscular recovery and enable the patient to cough up any blood remaining in the airways. OUTCOMES: The patient was successfully extubated and fully recovered with no complications. LESSONS: Blood aspiration due to oropharyngeal or nasopharyngeal bleeding can be diagnosed and treated by tracheobronchial suctioning via fiberoptic bronchoscopy. In addition, sugammadex can enable patients to recover spontaneous breathing, facilitate extubation, and enable patients to cough up any blood remaining in the airways.