FOREIGN BODY AIRWAY OBSTRUCTION: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv17n59-046Keywords:
Airway Obstruction, Foreign Bodies, Bronchoscopy, Respiratory AspirationAbstract
Introduction: Foreign body airway obstruction is a time-critical clinical emergency associated with preventable morbidity and mortality across pediatric and adult populations. Although the highest burden remains concentrated in children, recent evidence shows that clinically important events also occur in older adults, hospitalized patients, and individuals with neurological or swallowing impairment. The available literature has expanded in recent years, but it remains methodologically heterogeneous and multidisciplinary in scope.
Objective: The main objective of this systematic review was to synthesize contemporary evidence on foreign body airway obstruction with emphasis on epidemiology, clinical recognition, diagnosis, intervention, and outcomes. Secondary objectives were to compare age-related risk profiles, assess the diagnostic contribution of history, examination, imaging, and endoscopy, evaluate the effectiveness of initial airway clearance maneuvers and bronchoscopic interventions, analyze the evolving roles of rigid and flexible bronchoscopy, and identify major evidence gaps relevant to clinical practice and future research.
Methods: A systematic search was performed in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Studies published within the last five years were prioritized, with protocol allowance for expansion to ten years if necessary. Eligible designs included randomized and nonrandomized studies, observational cohorts, diagnostic studies, registry analyses, and clinically informative case series. Study selection and data extraction were conducted independently by reviewers according to PRISMA principles. Risk of bias was assessed with RoB 2, ROBINS-I, and QUADAS-2 as appropriate, and certainty of evidence was judged using GRADE.
Results and Discussion: Twenty studies were included in the final review. The evidence consistently showed that delayed diagnosis was associated with higher morbidity, more complex procedures, and greater pulmonary complication risk. Rigid bronchoscopy remained the principal definitive intervention in most confirmed pediatric cases, while recent data supported an expanding but selective role for flexible bronchoscopy in experienced centers and favorable anatomical contexts. Diagnostic scores such as FOBAS demonstrated promising accuracy in children, but no isolated clinical or radiographic feature reliably excluded aspiration. Recent population-based studies also suggested that bystander basic life support interventions were associated with improved obstruction relief and better survival-related outcomes.
Conclusion: Contemporary evidence supports a multidisciplinary and individualized approach to foreign body airway obstruction that integrates rapid recognition, prompt first-aid response, low threshold for bronchoscopy in high-suspicion cases, and context-sensitive procedural planning. The strongest recurring messages across the literature are the clinical importance of avoiding diagnostic delay and the need to align management with patient age, airway location, foreign body characteristics, and local expertise. Higher-quality prospective multicenter studies are still needed to improve certainty in diagnostic and comparative effectiveness questions.
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