Geriatric Trauma and Critical Care by Fred A. Luchette & Jay A. Yelon

Author:Fred A. Luchette & Jay A. Yelon
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

The aspiration of foreign bodies is the most common cause of acute airway obstruction in the geriatric population. Dental or medical appliances are the most common objects aspirated. Risk factors include dental procedures, conditions leading to depressed mental status, and dysphagia. Advanced age is not an independent risk factor for foreign body aspiration [5, 6]. However, elderly patients may be more likely to have a delay in diagnosis, with foreign body aspiration most commonly misdiagnosed as pneumonia or lung cancer [7].

The treatment of foreign body aspiration is via bronchoscopy, either rigid or flexible. The choice depends on the comfort level of the treating physician in most cases, but flexible bronchoscopy is more commonly utilized. Prior to inserting the bronchoscope, the patient’s airway should either be definitively secured, or preparations for an emergency airway should be in place.

A variety of bronchoscopic instruments can be used to retrieve foreign bodies including forceps, snares, baskets, and balloon catheters. Magnetic probes are available and can be useful for metallic objects. Occasionally, laser coagulation of surrounding granulation tissue is necessary in order to dislodge the object. If the identity of the foreign body is known and can be duplicated, it is often useful to determine what instrument would be most useful for retrieval extracorporeally. Bronchoscopy should be performed through the mouth to prevent loss of the object within the nasal passages. Once grasped, the scope, retrieval instrument, and foreign body should be removed together [6] (Fig. 21.1).

Fig. 21.1Bronchoscopic removal of aspirated foreign body

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