Interventional pulmonology (IP) represents a rapidly growing and developing subspecialty within pulmonary medicine. To the intensivist, given the elaborate undertakings with respect to airway, lung and pleural disease management-IP has shown an increasing presence and remain a major ally in the care of these patients. Thus, an understanding of the different roles that IP could offer to the intensivist is of prime importance in the multi-disciplinary care of the complex patients within the intensive care units, particularly in relation to lung, airway and pleural diseases. This review article will explore the different intersections of IP in critical care and discuss the applications of this discipline within the highly complex critical care environment.

• Hemoptysis
• Central airway obstruction
• Rigid bronchoscopy
• Critical care
• Tracheostomy

• Aspiration
• Dental drill
• Dental drill head
• Dental procedures
• Foreign body

• Epidemiology
• Foreign body aspiration
• Global burden of disease
• Prevention
• Sociodemographic index

• Humans
• Incidence
• Disability-Adjusted Life Years
• Male
• Global Health
• Female
• Foreign Bodies/epidemiology
• Foreign Bodies/mortality
• Child, Preschool
• Child
• Adult
• Middle Aged
• Infant
• Global Burden of Disease
• Aged
• Adolescent
• Young Adult

• Bronchoscopy
• Chronic cough
• Foreign body

• aspiration
• bronchoscopy
• computed tomography
• foreign body

• computed tomography
• foreign body
• obstructive pneumonia
• pepper

• study was supported by a Joint Project of Chongqing Science and Technology. Commission and Chongqing Public Health Commission
• the Senior Medical Talents Program of Chongqing for Young and Middle-aged from the Chongqing Health Commission
• This paper is available on ResearchSquare as a preprint

• bronchoscopy
• empyema of the chest
• foreign body aspiration
• high-frequency ventilation
• intensive care

• Bronchial foreign body
• Fish bone
• Long-term cough
• Obstructive pneumonia
• Past medical history

• bronchus foreign body
• cryoextraction
• invasive mycosis
• lung atelectasis

• COVID-19
• aspiration pneumonia
• case report
• differential diagnosis
• next generation sequencing—NGS

• Adult
• COVID-19
• High-Throughput Nucleotide Sequencing
• Humans
• Pandemics
• Pneumonia, Aspiration/diagnostic imaging
• SARS-CoV-2

• bronchoscopy
• cancer
• case report
• foreign body

• Aged
• Bronchoscopy/methods
• Carcinoma, Neuroendocrine/pathology
• Foreign Bodies
• Humans
• Male
• Mental Status and Dementia Tests
• Palliative Care/methods
• Respiratory Aspiration/surgery
• Stomach Neoplasms/pathology
• Terminal Care/methods

The clinical manifestations of foreign body (FB) aspiration can range from an asymptomatic presentation to a life-threatening emergency. Patients may present with acute onset cough, chest pain, breathlessness or sub-acutely with unexplained hemoptysis, non-resolving pneumonia and at times, as an incidental finding on imaging. Patients with iatrogenic FB such as an aspirated broken tooth during difficult intubation or a broken instrument are more common scenarios in the intensive care unit (ICU). Patients with post-obstructive pneumonia with or without sepsis, or variable degree of hemoptysis often require ICU level of care and bronchoscopic interventions. Rigid bronchoscopy has traditionally been the modality of choice; however, with the innovation in instrumentation and wider availability of flexible bronchoscopes, most of the FB removal is now successfully performed using flexible bronchoscopy. Proceduralists choose instruments in accordance with their training and expertise. We describe the use of most common instruments including forceps, balloon catheters, and baskets. Role of cryoprobe and LASER in FB removal is reviewed as well. In general, larger working channel bronchoscopes are preferred; however, smaller working channel bronchoscopes may be used in situations when the patients are intubated with a smaller diameter endotracheal or tracheostomy tubes. Large size FB are removed en bloc with the grasping tool, bronchoscope, and endotracheal or tracheostomy tube, requiring preparation to safely re-establish the airway. After FB removal, bronchoscopy is re-performed to identify any residual FB, assess any injury to the airway, suction post-obstructive secretions or pus, control any active bleeding and remove granulation tissue that may be obstructing the airway. Additional interventions like balloon dilatation may be required to dislodge an impacted FB or to maintain patency of bronchial lumen. If bronchoscopic methods fail, surgery may be required for retrieval of FB in symptomatic patients or to resect suppurative or necrotizing lung process. Multidisciplinary approach involving intensivists, surgeons, and anesthesiologists is the key to optimal patient outcomes.

• Foreign body (FB) aspiration
• bronchoscopy
• intensive care

The aspiration of objects and foreign bodies requires quick and systematic care. During emergent orotracheal intubation, accidental dental crown release can cause a threat to the patient's life. This paper aimed to report a case of foreign body (dental prosthetic crown) aspiration and its management and discuss alternative approaches. An 81-year-old male patient, who was admitted to the hospital's intensive care unit (ICU) for meningitis, presented with altered consciousness, and decreased oxygen saturation. He underwent emergent orotracheal intubation. After intubation, chest radiography was performed to check for proper orotracheal tube positioning and lung expansion. The resultant images revealed the presence of a foreign body within the right lower lobe bronchus in the shape of a dental crown. The foreign body, intubation cannula and basket clamp were successfully removed, followed by reintubation of the patient. The foreign body was a prosthetic upper premolar dental crown (24). While care should be taken to avoid complications, if a foreign body is aspirated during emergent orotracheal intubation, endoscopic removal appears safe and effective. Careful creation, placement, maintenance, and preservation of prosthetic crowns are critically important in elderly patients.

• Dental prosthetic crown
• Flexible bronchoscope
• Pulmonary aspiration

Foreign body aspiration (FBA) is more frequently presented in children and considered a rare presentation in adults. One of the most common causes of FBA in adults are orthodontic appliances.

We present a case of a 70-year-old male with an accidently discovered fixed partial denture (bridge) in the right mainstem bronchus. The partial denture was removed successfully by flexible bronchoscopy.

FBA is an event that most frequently occurs with children, and rarely with adults having various risk factors and complications on patients.

This study aims to spotlight the danger of asymptomatic FBA and how retrieving sharp objects can be managed by flexible bronchoscopy thus leading to better management and increased awareness of such cases.

•

Foreign Body Aspiration (FBA) is very uncommon in adults.

• Bronchoscopy
• Chronic cough
• Denture
• Foreign body aspiration

Tracheobronchial aspiration is relatively rare in adults as compared to children although incidence rates tend to increase with advancing age. The diagnosis of tracheobronchial foreign body aspiration can be challenging and warrants a high index of suspicion as the symptoms are often vague and patients may fail to recall the history of choking. The failure to diagnose the condition promptly may result in serious complications such as recurrent pneumonia, hemoptysis, or atelectasis. We present the case of a 72-year-old female with multiple comorbidities who presented with acute respiratory failure, which required urgent intubation and mechanical ventilation. Eventually, she was found to have aspirated green peas and pomegranate seeds, which were successfully removed by flexible bronchoscopy, leading to a dramatic improvement in both clinical condition and radiological imaging findings.

• aspiration
• lung cancer
• tracheobronchial foreign body

• Bronchi
• Bronchoscopy
• Cough/diagnostic imaging
• Cough/etiology
• Foreign Bodies/complications
• Foreign Bodies/diagnostic imaging
• Foreign Bodies/surgery
• Hemoptysis/diagnostic imaging
• Hemoptysis/etiology
• Humans
• Male
• Middle Aged
• Tomography, X-Ray Computed

• U01 CA152662 NCI NIH HHS

Tracheobronchial aspiration is a very common and serious medical condition. It can present acutely with an aspiration pneumonia, or it can be chronic and occur over a long period of time. In some instances, the diagnosis can be missed, and patients may be treated for years for other medical conditions such as asthma, with no significant improvement. We present here a very interesting case of a 69-year-old gentleman with multiple comorbidities who presented with a fever and shortness of breath. He was initially diagnosed with aspiration pneumonia, but when he did not improve, a bronchoscopy was performed, which showed a mass in the right bronchus suspicious for a carcinoid tumor. However, a biopsy was taken and sent to pathology for analysis, which showed food material. He underwent a rigid bronchoscopy for mass removal, which indeed confirmed that the whole mass was composed of food material as a result of tracheobronchial aspiration.

• aspiration
• bronchial carcinoid
• food bolus

• foreign body
• rigid bronchoscopy
• scarf pin
• secondary bronchus

• Clinical respiratory medicine
• cough
• radiology and other imaging

Flexible fiberoptic bronchoscopy is a rapid, cost effective and safe procedure.

To analyze demographic information and endoscopic findings in adult patients with airway foreign body aspiration and its removal.

Fifty-seven adults (40 males, 17 females; average age 40 years old) with airway foreign body aspiration were analyzed. Cough (37, 65%) was the most common clinical presentation. The most common foreign body was bone followed by dental prosthesis and food debris.

In the current study, 42 out of the 57 (74%) airway foreign bodies were successfully removed under flexible fiberoptic bronchoscopy. However, it was failed in 15 patients and thus, rigid bronchoscopy was used to remove foreign bodies successfully in 13 of the 15 patients. Thoracotomy was performed for the 2 patients whose foreign body removal was unsuccessful even with rigid bronchoscopy.

The findings of the current study revealed that flexible fiberoptic bronchoscopy is a safe and effective procedure for the removal of adult airway foreign bodies in the majority of cases. Rigid bronchoscopy can be a backup procedure in case flexible bronchoscopy is failed.

• Adult
• Airway foreign body
• Flexible fiberoptic bronchoscope

Foreign body aspiration is relatively infrequent in adults. Airway foreign bodies (AFBs) can be removed by flexible bronchoscopy (FB) or rigid bronchoscopy (RB). We performed a retrospective analysis of FBs performed in our centre over a 25 year period, focusing on the procedures that revealed an AFB during the examination stage. We recorded demographic data, clinical characteristics and radiological and bronchoscopic findings. During the study period, 12,588 FBs were performed in adults. Airway foreign bodies were identified in 32 of these cases, giving a prevalence of 0.25%. The most frequent clinical presentation was cough, sputum and fever. The most frequent radiological findings were alveolar infiltrates and atelectasis. In 94% of cases, AFBs were removed successfully by FB; RB was necessary in only 6% of cases. There were no FB-related complications. The most common AFB location was the right bronchial tree (69%). We classified AFBs as organic (85%: animal 57%; vegetable 28%), inorganic (6%) and iatrogenic (9%). Bronchial infection occurred in 51% of cases, and Actinomyces spp. was the most common causal microorganism. In conclusion, AFBs are a rare entity with nonspecific clinical presentation, most AFBs were organic, and FB is a safe and effective method for AFB removal.

• airway foreign bodies
• bronchoscopy
• flexible bronchoscopy

• cardiothoracic surgery
• ear, nose and throat/otolaryngology
• head and neck surgery
• otolaryngology / ENT

Patient: Male, 52

Final Diagnosis: Foreign body aspiration

Symptoms: Rhonchus • thoracic valve-like sensation

Medication: —

Clinical Procedure: —

Specialty: Pulmonology

Chronic retention of aspirated foreign bodies is rare but can result in indolent systemic and respiratory symptoms. Bronchoscopy may show features of tissue reaction to the foreign body, including granulation tissue, endobronchial stenosis, strictures, edema, and airway distortion. The diagnosis of foreign body aspiration is often difficult to establish since some patients may not give a clear history of aspiration or may present late. In addition, patients may be misdiagnosed with chronic pneumonia, bronchitis, asthma, or malignancy. We present the case of a 42-year-old male who had a chronically retained piece of an aluminum beverage container in the left mainstem bronchus for 12 years. Careful history, radiographic evaluation, and bronchoscopic examination revealed the foreign body, which was successfully extracted by rigid bronchoscopy.

• infectious diseases
• respiratory medicine

• Adult
• aspiration
• bronchoscopy
• complication
• foreign body (FB)
• technique

• respiratory aspiration
• tomography, x-ray computed
• lung
• aspiração respiratória
• tomografia computadorizada por raios x
• pulmão

• Deglutition Disorders/complications
• Deglutition Disorders/diagnostic imaging
• Humans
• Pneumonia, Aspiration/diagnostic imaging
• Pneumonia, Aspiration/etiology
• Tomography, X-Ray Computed

• Bronchoaspiration
• fibrobronchoscopy
• foreign body (FB)
• rigid bronchoscopy

Foreign body aspirations that are not recognized at the time of aspiration can lead to insidious symptoms that can present a diagnostic challenge. We report the case of a 70-year-old man presenting with postobstructive pneumonia 2 months after aspirating his own tooth during a meal. He had been mistakenly diagnosed with asthma and treated with bronchodilators before a computed tomography scan of the thorax revealed the impacted tooth in his left bronchus. We review the clinical features and microbiology of postobstructive pneumonia and discuss the rationale of its treatment.

• aspiration
• postobstructive pneumonia
• tooth

• Pharyngeal
• aspiration
• case report
• foreign body

Cayenne aspiration is an unusual type of foreign-body aspiration that is usually misdiagnosed. This article analyzes the clinical features of cayenne aspiration in the lower airway.

Clinical data on eight adult patients with cayenne aspiration were retrospectively analyzed. Six were elderly patients. The data were collected from Peking University First Hospital and Anhui Chest Hospital between January 2010 and August 2014.

The most common symptoms of cayenne aspiration were cough (eight cases, 100%) and sputum (five cases, 62.5%). Only one patient (12.5%) could supply the history of aspiration on his first visit to doctor and was diagnosed definitely without delay. The other seven cases were misdiagnosed as pneumonia and the time to accurate diagnosis was from 1 month to 6 months. The history of aspiration could be recalled after confirmed diagnosis for the other seven cases. The most common presentation shown by chest computed tomography (CT) was pneumonic opacity (eight cases, 100%). The existence of cayenne could not be detected by chest CT in any of the patients. All the patients were diagnosed definitively and managed successfully with flexible bronchoscopy. Cayenne was more often lodged in the right bronchus tree (seven cases, 87.5%), especially the right lower bronchus (four cases, 50%). The segment of cayenne was complete in five cases (62.5%) and scattered in three cases (37.5%).

The clinical features of cayenne aspiration are usually obscure and nonspecific which may lead to delay in diagnosis. Flexible bronchoscopy is safe and useful for early diagnosis and effective management.

• chest CT
• clinical features
• flexible bronchoscopy
• pneumonia