Foreign body removal
Clinical Snapshot
PICO Framework
| P — Population | Children under 5 years and adults over 65 years with airway foreign body aspiration |
| I — Intervention | Bronchoscopic extraction techniques (flexible and rigid bronchoscopy), multidetector computed tomography with 3D reconstruction |
| C — Comparator | Different bronchoscopic modalities compared to each other; advanced imaging compared to conventional methods |
| O — Outcomes | Diagnostic accuracy, procedural success rates, complication rates, extraction success |
Bottom Line
This narrative review provides a comprehensive overview of current approaches to airway foreign body management, highlighting significant advances in diagnostic imaging and therapeutic bronchoscopy. Multidetector CT with 3D reconstruction has achieved excellent diagnostic accuracy, particularly for radiopaque objects. Flexible bronchoscopy has emerged as a viable first-line therapeutic option with 87% success rates in pediatric populations, though rigid bronchoscopy remains essential for emergency presentations and complex cases. The review emphasizes the importance of individualized, multidisciplinary management approaches. However, as a narrative review without systematic methodology, the evidence synthesis lacks the rigor expected for definitive practice recommendations. Clinicians should interpret these findings within the context of their institutional capabilities and consider this as expert opinion rather than systematic evidence synthesis.
Key Findings
P Value: Not reported
Effect Size: Flexible bronchoscopy success rate: 87% (pediatric meta-analyses)
Primary Outcome: Diagnostic accuracy and procedural success rates for foreign body removal
Nnt Or Sensitivity: CT sensitivity: 98-99% (radiopaque objects), 85-92% (radiolucent objects)
Confidence Interval: Not reported
Clinical Application
Requires specialized bronchoscopy expertise, advanced imaging capabilities, and appropriate instrumentation available in tertiary centers Relevant to Australian emergency departments and respiratory medicine services. Aligns with RACGP emergency care guidelines. Advanced imaging techniques supported by Medicare for appropriate indications Pediatric patients under 5 years and elderly adults over 65 years presenting with suspected airway foreign body aspiration
Abstract
PURPOSE OF REVIEW: Airway foreign body aspiration remains a potentially life-threatening emergency, predominantly affecting children under 5 years and adults over 65 years. This review synthesizes current evidence on diagnostic strategies, bronchoscopic extraction techniques, procedural outcomes, complication management, and emerging technologies in airway foreign body management. RECENT FINDINGS: Multidetector computed tomography with three-dimensional reconstruction has significantly improved diagnostic accuracy, achieving sensitivity of 98-99% for radiopaque objects and 85-92% for radiolucent materials. Flexible bronchoscopy has evolved from a diagnostic tool to a first-line therapeutic modality, with recent pediatric meta-analyses demonstrating 87% success rates and adult series showing comparable outcomes to rigid bronchoscopy for appropriately selected cases. Rigid bronchoscopy maintains superiority in asphyxiating presentations, and for large (>1.5 cm), sharp, or severely impacted foreign bodies. Technological innovations including robotic-assisted bronchoscopy, electromagnetic navigation systems, and artificial intelligence-powered imaging analysis are enhancing procedural precision and safety. SUMMARY: Successful airway foreign body management requires individualized, multidisciplinary approaches integrating patient clinical status, foreign body characteristics, and institutional expertise. Success depends on appropriate bronchoscopic modality selection, comprehensive preprocedural planning, availability of specialized retrieval instruments, and readiness to manage potential complications. Integration of advanced imaging, simulation-based training protocols, and telemedicine consultation are becoming essential components of contemporary practice.
References
- 1.Goyal, R., Sehgal, I. S., & Agarwal, R. (2026). Foreign body removal. Current Opinion in Pulmonary Medicine, 32(1). https://doi.org/10.1097/MCP.0000000000001225
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