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Morales CZ, Barrette LX, Vu GH, Kalmar CL, Oliver E, Gebb J, Feygin T, Howell LJ, Javia L, Hedrick HL, Adzick NS, Jackson OA. Postnatal outcomes and risk factor analysis for patients with prenatally diagnosed oropharyngeal masses. Int J Pediatr Otorhinolaryngol 2022; 152:110982. [PMID: 34794813 DOI: 10.1016/j.ijporl.2021.110982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe our experience treating prenatally diagnosed oropharyngeal masses in a novel, multidisciplinary collaboration. To identifying outcomes and risk factors associated with adverse postnatal outcomes. METHODS This is a sixty-two patient case series at an academic referral center. Patients with prenatally diagnosed oropharyngeal masses were identified through a programmatic database and confirmed in the electronic health record. RESULTS Sixty-two patient with prenatally diagnosed oropharyngeal mass were identified, with prenatal imaging at our institution confirming this diagnosis in fifty-seven patients, short term outcomes analysis conducted on forty-four patients, and long-term outcomes analysis conducted on seventeen patients. The most common pathology was lymphatic malformations (n = 27, 47.4%), followed by teratomas (n = 22, 38.6%). The median mass volume from all available patient imaging (n = 57) was 60.54 cm3 (range 1.73-742.5 cm3). Thirteen pregnancies were interrupted, six infants expired, and thirteen cases had an unknown fetal outcome. Confirmed mortality was 6/57 patients with imaging-confirmed oropharyngeal masses (10.5%). Fourteen (56%) of the surviving patients (n = 25) were delivered by Ex Utero Intrapartum Treatment (EXIT) procedure and the median NICU stay was thirty-six days (range: 3-215 days). There was no association between airway compression/deviation/displacement, stomach size, polyhydramnios, or mass size and mortality. Seventeen patients had more than one year of follow-up (mean 5.3 ± 2.4 years). These seventeen patients underwent general anesthesia a total of ninety-two times (mean 5.4 ± 4.3) and had a total of twenty-three mass-related surgeries. The great majority of patients required an artificial airway at birth, feeding support, and speech/swallow therapy. CONCLUSIONS Oropharyngeal mass involvement of key anatomic structures-the neck, upper thorax, orbit, and ear, has a greater association with mortality than mass size. Regardless of the size and involved structures, oropharyngeal masses are associated with a high burden of intensive medical care and surgical care beginning at or before birth.
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Affiliation(s)
- Carrie Z Morales
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Louis-Xavier Barrette
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Giap H Vu
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Christopher L Kalmar
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Edward Oliver
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Juliana Gebb
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Tamara Feygin
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Luv Javia
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Holly L Hedrick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Oksana A Jackson
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Venkatachalam SJ, Garcia-Marcinkiewicz A, Giordano R, Stow J, Lioy J, Javia L, Tay KY, Romer A, Soorikian L, Napolitano N, McCloskey J, Nadkarni V, Fiadjoe J, Nishisaki A. Operations and outcomes of a Hospital-wide Emergency Airway Response Team (HEART) in a quaternary academic children's hospital. Paediatr Anaesth 2021; 31:1105-1112. [PMID: 34176182 DOI: 10.1111/pan.14249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/13/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To improve pediatric airway management outside of the operating room, a Hospital-wide Emergency Airway Response Team (HEART) program composed of anesthesiology, otorhinolaryngology, and respiratory therapy clinicians was developed. AIMS To report processes and outcomes of HEART activations in a quaternary academic children's hospital. METHODS A retrospective observational cohort study between January 2017 and December 2019. Local airway emergency database was reviewed for HEART activations. Additional safety data was obtained from patients' electronic health records. PRIMARY OUTCOME Adverse airway outcomes, either adverse tracheal intubation-associated events or oxygen desaturation (SpO2 <80%). We compared airway management by primary teams before HEART arrival and by HEART after arrival. RESULTS Of 96 HEART activations, 36 were from neonatal intensive care unit, 35 from pediatric and cardiac intensive care units, 14 from emergency department, and 11 from inpatient wards. 56 (62%) children had airway anomalies and 41/96 (43%) were invasively ventilated. Median HEART arrival time was 5 min (interquartile range, 3-5). 56/96 (58%) required insertion of an advanced airway (supra/extra-glottic airway, endotracheal tube, tracheostomy tube). HEART succeeded in establishing a definitive airway in 53/56 (94%). Adverse airway outcomes were more common before (56/96, 58%) versus after HEART arrival (28/96, 29%; absolute risk difference 29%; 95% confidence interval 16, 41%; p < .001). Oxygen desaturation occurred more frequently before (46/96, 48%) versus after HEART arrival (24/96, 25%; absolute risk difference 23%; 95% confidence interval 11, 35%; p = .02). Cardiac arrests were more common before (9/96, 9%) versus after HEART arrival (3/96, 3%). Multiple (≥3) intubation attempts were more frequent before (14/42, 33%) versus after HEART arrival (9/46, 20%; absolute risk difference -14%; 95% confidence interval -32, 5%; p = .15). CONCLUSIONS A multidisciplinary emergency airway response team plays an important role in pediatric airway management outside of the operating room. Adverse airway outcomes were more frequent before compared to after HEART arrival.
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Affiliation(s)
- Shakthi Jayanthy Venkatachalam
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Annery Garcia-Marcinkiewicz
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rita Giordano
- Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joanne Stow
- Department of Otorhinolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Janet Lioy
- Department of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Luv Javia
- Department of Otorhinolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Khoon-Yen Tay
- Department of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amy Romer
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Leane Soorikian
- Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Natalie Napolitano
- Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John McCloskey
- Department of Pediatric Anesthesia and Critical Care, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John Fiadjoe
- Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Akira Nishisaki
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Zimmerman CE, Barrette LX, Kalmar C, Huy Vu G, Javia L, Jackson O. Long-term Risk-Factors and Outcomes of 62 Patients with Prenatally Diagnosed Oropharyngeal Masses. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Matava CT, Kovatsis PG, Summers JL, Castro P, Denning S, Yu J, Lockman JL, Von Ungern-Sternberg B, Sabato S, Lee LK, Ayad I, Mireles S, Lardner D, Whyte S, Szolnoki J, Jagannathan N, Thompson N, Stein ML, Dalesio N, Greenberg R, McCloskey J, Peyton J, Evans F, Haydar B, Reynolds P, Chiao F, Taicher B, Templeton T, Bhalla T, Raman VT, Garcia-Marcinkiewicz A, Gálvez J, Tan J, Rehman M, Crockett C, Olomu P, Szmuk P, Glover C, Matuszczak M, Galvez I, Hunyady A, Polaner D, Gooden C, Hsu G, Gumaney H, Pérez-Pradilla C, Kiss EE, Theroux MC, Lau J, Asaf S, Ingelmo P, Engelhardt T, Hervías M, Greenwood E, Javia L, Disma N, Yaster M, Fiadjoe JE. Pediatric Airway Management in COVID-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society. Anesth Analg 2020; 131:61-73. [PMID: 32287142 PMCID: PMC7173403 DOI: 10.1213/ane.0000000000004872] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 12/14/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.
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Affiliation(s)
- Clyde T. Matava
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pete G. Kovatsis
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
| | - Jennifer Lee Summers
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Pilar Castro
- Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio
| | - Simon Denning
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Yu
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Justin L. Lockman
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Stefano Sabato
- Department of Anaesthesia and Pain Management, The Royal Children’s Hospital, Victoria, Australia
| | - Lisa K. Lee
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
| | - Ihab Ayad
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
| | - Sam Mireles
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
| | - David Lardner
- Department of Anesthesia, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Simon Whyte
- Department of Anesthesiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Judit Szolnoki
- Department of Anesthesiology; University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
| | | | - Nicole Thompson
- Department of Anesthesiology, Shriners Hospitals for Children, Chicago, Illinois
| | - Mary Lyn Stein
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nicholas Dalesio
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Robert Greenberg
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - John McCloskey
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - James Peyton
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia
- Department of Anaesthesia and Pain Management, The Royal Children’s Hospital, Victoria, Australia
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
- Department of Anesthesia, Alberta Children’s Hospital, Calgary, Alberta, Canada
- Department of Anesthesiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Department of Anesthesiology; University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
- Department of Anesthesiology, Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Anesthesiology, Shriners Hospitals for Children, Chicago, Illinois
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
- Department of Anesthesiology, Duke University, Durham, North Carolina
- Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest, North Carolina
- Department of Anesthesiology and Pain Medicine, Akron Children’s Hospital, Northeast Ohio Medical University, Akron, Ohio
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
- Department of Anesthesia, Hospital Son Espases, Illes Balears, Spain
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology, Instituto de Ortopedia Infantil Roosevelt, Bogotá, Colombia
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
- Department of Anesthesiology and Pediatrics, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Anesthesiology, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Anesthesiology, Arkansas Children’s Hospital & University of Arkansas & Medical Science Center, Little Rock, Arkansas
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
- /label>Pediatric Anesthesia Unit, Cardiac and Neonatal Section, Gregorio Marañón University Hospital, Madrid, Spain
- Department of Otorhinolaryngology Head and Neck Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Faye Evans
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
| | - Bishr Haydar
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
| | - Paul Reynolds
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
| | - Franklin Chiao
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Brad Taicher
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Thomas Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest, North Carolina
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Akron Children’s Hospital, Northeast Ohio Medical University, Akron, Ohio
| | - Vidya T. Raman
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
| | | | - Jorge Gálvez
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan Tan
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mohamed Rehman
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christy Crockett
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Patrick Olomu
- Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas
| | - Peter Szmuk
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Chris Glover
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Maria Matuszczak
- Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
| | - Ignacio Galvez
- Department of Anesthesia, Hospital Son Espases, Illes Balears, Spain
| | - Agnes Hunyady
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - David Polaner
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Cheryl Gooden
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Grace Hsu
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Harshad Gumaney
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Edgar E. Kiss
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
| | - Mary C. Theroux
- Department of Anesthesiology and Pediatrics, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Lau
- Department of Anesthesiology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Saeedah Asaf
- Department of Anesthesiology, Arkansas Children’s Hospital & University of Arkansas & Medical Science Center, Little Rock, Arkansas
| | - Pablo Ingelmo
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
| | - Thomas Engelhardt
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
| | - Mónica Hervías
- /label>Pediatric Anesthesia Unit, Cardiac and Neonatal Section, Gregorio Marañón University Hospital, Madrid, Spain
| | - Eric Greenwood
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Luv Javia
- Department of Otorhinolaryngology Head and Neck Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nicola Disma
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Myron Yaster
- Department of Anesthesiology, Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - John E. Fiadjoe
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
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Wertz A, Fuller SM, Mascio C, Sobol SE, Jacobs IN, Javia L. Slide tracheoplasty: Predictors of outcomes and literature review. Int J Pediatr Otorhinolaryngol 2020; 130:109814. [PMID: 31862500 DOI: 10.1016/j.ijporl.2019.109814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Determine preoperative comorbidities and intraoperative parameters associated with adverse postoperative outcomes. METHODS Retrospective case series at a single tertiary care children's hospital from 2010 through 2017. RESULTS Twenty-six patients with median age of 6 months and median weight of 7.1 kg underwent slide tracheoplasty. Median time to extubation, length of intensive care unit admission, and length of hospitalization were 7, 27, and 30 days, respectively. Twenty-two (85%) required no additional intervention. Overall success was 87%. One (4%) patient required open revision, and 3 (11%) required tracheostomy. Concomitant cardiac surgery was associated with postoperative tracheostomy (p = 0.04). Age and weight at surgery were inversely correlated with length of intubation (p = 0.03) and length of hospital stay (p = 0.001, p = 0.002) respectively. Hospital stay was 2.2 times longer if preoperative mechanical ventilation was required (p = 0.01) and 39% longer for every 1 mm decrease in airway diameter at the narrowest portion of the stenosis (p = 0.005). There were no deaths related to persistent tracheal stenosis with a median follow-up of 24 months. CONCLUSION Slide tracheoplasty is safe and effective. Concomitant cardiac surgery was associated with postoperative tracheostomy. Lower age and weight at surgery were correlated with longer length of intubation and hospital stay. Preoperative mechanical ventilation and smaller airway diameter were associated with longer hospital stay. This information may be helpful in counseling families and planning future prospective studies.
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Affiliation(s)
- Aileen Wertz
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Stephanie M Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Christopher Mascio
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Steven E Sobol
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Ian N Jacobs
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Luv Javia
- Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Abstract
Congenital causes of airway obstruction once noted at birth are now diagnosed prenatally. The adoption of ex utero intrapartum treatment has allowed for planned airway stabilization on placental support, dramatically decreasing the incidence of hypoxic injury or peripartum demise related to neonatal airway obstruction. Airway access is gained either through laryngoscopy, bronchoscopy, or a surgical airway. In complete airway obstruction, primary resection of the obstructing lesion may be performed before completion of delivery. This article reviews the current and emerging methods of fetal evaluation, indications for ex utero intrapartum treatment, and provides a detailed description of the procedure and necessary personnel.
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Affiliation(s)
- Kara Prickett
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, 1400 Tullie Road, NE, Atlanta, GA 30329, USA.
| | - Luv Javia
- Cochlear Implant Program, Center for Pediatric Airway Disorders, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Affiliation(s)
- Janet Lioy
- Division of Neonatology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
| | - Luv Javia
- Division of Otolaryngology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.
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Javia L, Brant J, Guidi J, Rameau A, Pross S, Cohn S, Kazahaya K, Dunham B, Germiller J. Infectious complications and ventilation tubes in pediatric cochlear implant recipients. Laryngoscope 2015; 126:1671-6. [PMID: 26343393 DOI: 10.1002/lary.25569] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 06/29/2015] [Accepted: 07/22/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS At many centers, ventilating tubes (VTs) are placed routinely in otitis-prone pediatric cochlear implant recipients. However, this practice is controversial, as many otologists believe VTs represent a possible route for contamination of the device. Toward better understanding of the safety of VTs, we reviewed our center's infectious complications and their relationship to the presence of tubes. STUDY DESIGN Retrospective cohort study. METHODS All patients undergoing cochlear implantation at our institution between 1990 and 2012 were reviewed for complications and their association with the presence of VTs. RESULTS A total of 478 patients (557 ears) were reviewed, representing over 2,978 patient-years of follow-up. In 135 ears (24.2%), a VT was present at time of, or placed at some point after, implantation. The remainder either never had a VT or it had extruded prior to implantation. Overall, 63 complications occurred, of which 17 were infectious. The most common were cellulitis (four), device infection (five), and meningitis (four). Only one occurred while a tube was present, and was a device infection in an ear having a retained VT in place for almost 4 years. No difference was observed in overall rates of infectious complications between the group with VTs and those who never had VTs. CONCLUSIONS This series, the largest to date, indicates that infectious complications after cochlear implantation are rarely associated with the presence of VTs, supporting the concept that, overall, VTs are safe in cochlear implant recipients. Close monitoring is essential, including prompt removal of tubes when they are no longer needed. LEVEL OF EVIDENCE 4. Laryngoscope, 126:1671-1676, 2016.
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Affiliation(s)
- Luv Javia
- Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jason Brant
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jessica Guidi
- Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anaïs Rameau
- Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Seth Pross
- Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Samuel Cohn
- Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Brian Dunham
- Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - John Germiller
- Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Li MH, Eberhard M, Mudd P, Javia L, Zimmerman R, Khalek N, Zackai EH. Total colonic aganglionosis and imperforate anus in a severely affected infant with Pallister-Hall syndrome. Am J Med Genet A 2015; 167A:617-20. [PMID: 25604768 DOI: 10.1002/ajmg.a.36915] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/23/2014] [Indexed: 12/28/2022]
Abstract
Pallister-Hall syndrome is a complex malformation syndrome characterized by a wide range of anomalies including hypothalamic hamartoma, polydactyly, bifid epiglottis, and genitourinary abnormalities. It is usually caused by truncating frameshift/nonsense and splicing mutations in the middle third of GLI3. The clinical course ranges from mild to lethal in the neonatal period. We present the first patient with Pallister-Hall syndrome reported with total colonic aganglionosis, a rare form of Hirschsprung disease with poor long-term outcome. The patient also had an imperforate anus, which is the third individual with Pallister-Hall syndrome reported with both Hirschsprung disease and an imperforate anus. Molecular testing via amniocentesis showed an apparently de novo novel nonsense mutation c.2641 C>T (p.Gln881*). His overall medical course was difficult and was complicated by respiratory failure and pan-hypopituitarism. Invasive care was ultimately withdrawn, and the patient expired at three months of age. This patient's phenotype was complex with unusual gastrointestinal features ultimately leading to a unfavorable prognosis and outcome, highlighting the range of clinical severity in patients with Pallister-Hall syndrome.
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Affiliation(s)
- Mindy H Li
- Division of Human Genetics, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract
Objective To conduct a systematic review of published articles that describe simulators that could be used in otolaryngology for education, skill acquisition, and/or skill improvement. Data Sources Ovid and Embase databases searched July 14, 2011. Review Methods Three hundred fifty-three abstracts were independently reviewed by both authors, then 154 eligible articles were reviewed by both authors, and 95 articles were categorized by organ system (eg, otologic); type of simulator (eg, physical, virtual); whether the simulator was a prototype, could be purchased, or was constructed; validation; and level of learning assessment. Discrepancies were resolved by re-review and discussion. Results In addition to 11 overview articles, 28 articles described 16 otology simulators, most of which are virtual and prototypes. Ninteen articles described 10 sinus/rhinology simulators; most are virtual surgery simulators and prototypes. Eight articles described 8 oral cavity simulators, and 8 articles described neck simulators. Seventeen articles described 13 bronchoscopy simulators; several are full-body high-technology manikins adapted from other purposes. Five articles described eclectic simulators, including some for learning nontechnical and teamwork skills. Half of the simulators have been validated. Learning levels were often not assessed or assessment was limited to the learners’ perceptions. Conclusion A wide variety of simulators are available or under development. Lack of unified validation concepts and limited descriptions restricted our ability to assess model characteristics, availability, and validation. Simulators are emerging as powerful tools to facilitate learning; this review may provide a platform for discussion and refinement of the information reported and analyzed in evaluating simulators.
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Affiliation(s)
- Luv Javia
- Division of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Department of Otorhinolaryngology/Head and Neck Surgery, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ellen S. Deutsch
- Center for Simulation, Advanced Education and Innovation, Department of Anesthesiology and Critical Care Medicine, the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Berg E, Kazahaya K, Javia L. Post-Transplant Lymphoproliferative Disorder of the Temporal Bone: Report of a Unique Case and Discussion. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Javia L, Dunham B, Kazahaya K. Novel Use of Radiofrequency Plasma Ablation (Coblation) in the Endonasal Resection of a Stage IIIb Juvenile Nasopharyngeal Angiofibroma. Skull Base 2009. [DOI: 10.1055/s-2009-1242416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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