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Fernández Monteagudo B, Piris Borregas S, Niño Díaz L, Carbayo Jiménez T, Morante Valverde R, Redondo Sedano JV, Moral Pumarega MT. Tracheal agenesis: the importance of teamwork in an uncommon pathology, challenging diagnosis, and high mortality-a case report. Front Pediatr 2024; 12:1401729. [PMID: 39055618 PMCID: PMC11269142 DOI: 10.3389/fped.2024.1401729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction We present the case of a patient with an unexpected postnatal diagnosis of tracheal agenesis, a severe and rare pathology with fewer than 200 cases documented in the literature, typically diagnosed postmortem. In our instance, early diagnosis was achieved through collaborative efforts and teamwork among various professionals. We provide illustrative images and videos to assist colleagues in identifying this congenital anomaly. Case presentation The patient is a term newborn with prenatal indicators of polyhydramnios and a single umbilical artery. Upon birth, the infant exhibited severe respiratory distress, and orotracheal intubation via direct laryngoscopy was unfeasible. Consequently, an urgent fibrobronchoscopy, conducted by pediatric surgeons, led to the diagnosis of tracheal agenesis with tracheoesophageal fistula and the placement of a directed endotracheal tube. This intervention facilitated temporary ventilation until parental consensus on management was achieved. Following a multidisciplinary consultation, the decision was made to proceed with extracorporeal membrane oxygenation. Unfortunately, the patient experienced a prolonged refractory cardiorespiratory arrest and died after 7 h of life in his mother's arms. Conclusion Teamwork in neonatology is indispensable when addressing emergent pathologies. In our experience, multidisciplinary management, including anesthesiologists and pediatric surgeons, should be contemplated in complex scenarios.
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Affiliation(s)
| | | | - Lidia Niño Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, Spain
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Lechien JR. Management of Pediatric Bilateral Vocal Fold Paralysis: A State-of-the-Art Review of Etiologies, Diagnosis, and Treatments. CHILDREN (BASEL, SWITZERLAND) 2024; 11:398. [PMID: 38671615 PMCID: PMC11049505 DOI: 10.3390/children11040398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE This paper reviews the current literature about epidemiology, etiologies, diagnosis, and management of pediatric bilateral vocal fold paralysis (PBVFP). METHODS According to PRISMA statements, a narrative review of the current literature was conducted through the PubMed, Scopus, and Cochrane Library databases about the epidemiology, etiologies, diagnosis, and management of PBVFP. RESULTS PBVCP is the second most common congenital laryngeal anomaly in the pediatric population, accounting for 10% to 20% of pediatric laryngeal conditions. PBVCP is related to idiopathic (42.2%), congenital (19.7%), and neurological (16.9%) conditions. A tracheotomy is required in 60% of cases regarding stridor and dyspnea, which are the most prevalent symptoms. The diagnosis is based on the etiological features, clinical presentation, laryngoscopic findings, and objective examinations. Laryngeal electromyography may be used to support the diagnosis in difficult cases, but its reliability depends on the practitioner's experience. The primary differential diagnosis is posterior glottis stenosis, which needs to be excluded regarding therapeutic and management differences with PBVCP. Transient surgical procedures consist of tracheotomy or laterofixation of the vocal fold. Current permanent procedures include uni- or bilateral partial arytenoidectomy, posterior transverse cordotomy, cricoid splits, and laryngeal selective reinnervation. There is no evidence of the superiority of some procedures over others. CONCLUSIONS PBVCP is the second most common laryngeal disorder in the pediatric population. Diagnosis is based on etiological and clinical findings and may require the use of laryngeal electromyography. Therapeutic management may involve several transient or permanent surgical procedures that are associated with overall subjective improvements in symptoms, laryngeal findings, and low complication rates.
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Affiliation(s)
- Jerome R. Lechien
- Research Committee of the Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, 92150 Paris, France;
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, B1000 Brussels, Belgium
- Department of Otolaryngology, Elsan Hospital, 92150 Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
- Division of Laryngology and Bronchoesophagology, Department of Otolaryngology Head Neck Surgery, Faculty of Medicine, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), B7000 Mons, Belgium
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B A, S A, M A, Siddesh SS, Rao S, Pandya HJ. A Multi-armed Unfurling Actuator for Airway Lumen Measurement. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082710 DOI: 10.1109/embc40787.2023.10340671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objective measurement of the lumen area demands an intraoperative diagnostic tool to aid on-site decision-making. We present a compliant mechanism-based unfurling actuator assembly integrated with a shaft connected to a motorized encoder to translate torque from the user at the proximal end to the actuator at the distal end. The actuator assembly has flexible arms coiled inside a cylindrical casing that moves radially outward upon actuation. Leveraging 3D printing of flexible materials, the unfurling actuator's four-arm design enables patency measurements in circumferential tracheal stenosis of varying grades. The rotary encoder output is correlated with the radially outward movement of the unfurling arms to estimate the lumen diameter. The measurement stability is analyzed using process control charts; data distribution over ten iterations reveals nearly 100% of process data falls between ±3 sigma (Upper and Lower control limits). Comparing measurements from the tool with direct measurement (vernier caliper) and ImageJ analysis, one-way ANOVA for circular morphology yields no significant differences in diameter p = 0.974 and area measurements p = 0.975.Clinical Relevance- Central airway narrowing reduces the effective lumen area in the tracheal and bronchial segments. Grading the degree of narrowing is often based on a suspicion index. A quick but thorough assessment of the airway caliber is essential in emergent or planned intubation, whether congenital, iatrogenic, or idiopathic tracheal stenosis.
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Wang S, Li Z, Guan W, Zhang J. Unsuspected severe tracheal stenosis and tracheomalacia after correction surgery for congenital scoliosis: A case report. Paediatr Anaesth 2023; 33:167-169. [PMID: 36217730 DOI: 10.1111/pan.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 08/19/2022] [Accepted: 09/24/2022] [Indexed: 01/21/2023]
Abstract
Tracheal stenosis and tracheomalacia in patients with congenital scoliosis are serious and rare conditions caused by congenital dysplasia, postintubation injury, trauma, and tracheal tumor. Anesthesia of a child with tracheal stenosis is challenging for anesthesiologists. We describe an 8-year-old female patient developed severe tracheal stenosis and tracheomalacia after growing rod implantation for congenital scoliosis. Comprehensive assessment of preoperative pulmonary function and airway morphology, which can be neglected clinically, should be performed in congenital scoliosis patients.
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Affiliation(s)
- Shengru Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Ziquan Li
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Wenmin Guan
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
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Morais CG, Baptista C, Grilo M, Moreira A, Ribeiro A. Challenging Diagnosis of a Congenital Tracheal Malformation: Considerations From an Intensive Care Perspective. Cureus 2023; 15:e34404. [PMID: 36874726 PMCID: PMC9978948 DOI: 10.7759/cureus.34404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
Congenital tracheal stenosis is a rare airway malformation. A high index of suspicion is fundamental. The authors report a case of congenital tracheal stenosis in a 13-month-old male infant, with a challenging diagnosis from the intensive care perspective. At birth, the patient presented an anorectal malformation with a recto-urethral fistula so a colostomy with mucous fistula was performed in the neonatal period. At the age of seven months, he was admitted due to a respiratory infection, treated with steroids and bronchodilators, and discharged after three days without any complications. He underwent complete repair of tetralogy of Fallot when he was 11 months old, which was performed without any reported perioperative complications. However, at the age of 13 months, due to another respiratory infection, he presented more severe symptoms and required admission to the pediatric intensive care unit (PICU) for invasive mechanical ventilation. He was intubated on the first attempt. While monitoring the difference between peak inspiratory and plateau pressures, we observed a sustained elevated difference between pressures suggestive of increased airway resistance, thus raising the possibility of an anatomical obstruction. Laryngotracheoscopy confirmed distal tracheal stenosis (grade II) with four complete tracheal rings. In our case, the absences of perioperative challenges or complications in previous respiratory infections were not suggestive of a tracheal malformation. Furthermore, no difficulties were encountered during intubation due to the distal location of the tracheal stenosis. A careful appreciation of respiratory mechanics on the ventilator at rest and during tracheal aspirations was essential to suspect an anatomical defect.
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Affiliation(s)
- Catarina G Morais
- Pediatrics, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - Carolina Baptista
- Pediatric Intensive Care Unit, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - Marta Grilo
- Pediatric Intensive Care Unit, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - Amélia Moreira
- Pediatric Intensive Care Unit, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - Augusto Ribeiro
- Pediatric Intensive Care Unit, Centro Hospitalar e Universitário de São João, Porto, PRT
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Pizzarro J, Quan T, Manzi JE, Chen FR, Gu A, Tabaie S. Evaluating the association between pulmonary abnormalities and complications following pediatric hip dysplasia surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1193-1199. [PMID: 35534638 DOI: 10.1007/s00590-022-03276-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) encompasses a wide range of abnormal hip development and is a common condition in the pediatric population. Congenital pulmonary abnormalities are typically mild in the pediatric population but can be associated with severe comorbid conditions. The purpose of this study was to analyze the effect of structural pulmonary/airway abnormalities on the incidence of postoperative complications following surgical management of DDH. METHODS From 2012 to 2019, the National Surgical Quality Improvement Program-Pediatric database was utilized to identify pediatric patients undergoing surgical treatment for hip dysplasia. Patients were stratified into two groups: patients with a structural pulmonary/airway abnormality and patients without a pulmonary abnormality. Patient demographics, comorbidities, and postoperative complications were compared between the two cohorts with the use of various statistical analyses, including bivariate and multivariate analyses. RESULTS Of the 10,853 patients who underwent surgical treatment for hip dysplasia, 10,157 patients (93.6%) did not have a structural pulmonary/airway abnormality whereas 696 (6.4%) had an airway abnormality. Following adjustment on multivariate analysis, patients with a structural pulmonary abnormality had an increased risk of cardiac arrest requiring cardiopulmonary resuscitation (OR 2.342; p = 0.045). CONCLUSION The results indicated that patients with a structural pulmonary abnormality had an increased risk of cardiac arrest requiring cardiopulmonary resuscitation compared to those without a pulmonary abnormality. Ensuring appropriate preoperative evaluation with a multidisciplinary team and close monitoring postoperatively is important to prevent the risk of severe outcomes in this vulnerable patient population.
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Affiliation(s)
- Jordan Pizzarro
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, 2300 Eye St NW, Washington, DC, 20037, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, 2300 Eye St NW, Washington, DC, 20037, USA.
| | - Joseph E Manzi
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Frank R Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, 2300 Eye St NW, Washington, DC, 20037, USA
| | - Sean Tabaie
- Department of Orthopaedic Surgery, Children's National Health System, Washington, DC, USA
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