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Ramesh A, Gupta KK, Deep G, Singh A. Airway management of postburn neck contracture in pediatric patient - A challenge for anesthesiologist! Saudi J Anaesth 2024; 18:286-289. [PMID: 38654874 PMCID: PMC11033884 DOI: 10.4103/sja.sja_793_23] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 04/26/2024] Open
Abstract
Pediatric difficult airway management is more challenging for an anesthesiologist due to anatomical and physiological differences as compared to adults. Moreover, the familiarity with the use of difficult airway equipment in adults does not equate to proficiency for the same in children. So, here we are presenting the management of a unique case of a difficult airway due to postburn neck contracture in a 4-year-old child, which was managed successfully with the help of a video laryngoscope after the failure attempt with a flexible fiberoptic bronchoscope.
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Affiliation(s)
- Athira Ramesh
- Department of Anaesthesia and Intensive Care, Baba Farid University of Health Sciences, Faridkot, Punjab, India
- Department of Anaesthesia and Intensive Care, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Kewal K. Gupta
- Department of Anaesthesia and Intensive Care, Baba Farid University of Health Sciences, Faridkot, Punjab, India
- Department of Anaesthesia and Intensive Care, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Gagan Deep
- Department of Anaesthesia and Intensive Care, Baba Farid University of Health Sciences, Faridkot, Punjab, India
- Department of Anaesthesia and Intensive Care, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Amanjot Singh
- Department of Anaesthesia and Intensive Care, Baba Farid University of Health Sciences, Faridkot, Punjab, India
- Department of Anaesthesia and Intensive Care, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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Klatzkow H, Gitomer S, St John-Larkin C, Scholes MA, Cooper E. Prevalence of Postpartum Depression in Mothers Presenting to a Pediatric Otolaryngology Clinic. Laryngoscope 2024; 134:973-976. [PMID: 37462331 DOI: 10.1002/lary.30901] [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] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES To further understand specific risk factors for the development of postpartum depression (PPD) amongst mothers of infants with common otolaryngologic diagnoses. METHODS A prospective cohort study was performed to screen for PPD in mothers of infants presenting to the pediatric otolaryngology clinic. After obtaining consent for inclusion, subjects were administered the Edinburgh Postnatal Depression Scale, which was completed during the visit. The primary outcome measure was the rate of positive screening, with additional data obtained to include demographic and diagnostic information. RESULTS The overall rate for positive PPD screening in included subjects was 18.8%. An increased rate of positive PPD screening was demonstrated amongst the subgroups of frequent noisy breathing (25%) and lip tie (26.7%). CONCLUSION This study provides additional insight into risk factors for the development of PPD. This highlights the potential benefit of increased screening within the population of mothers presenting to the pediatric otolaryngologic clinic, which could improve long-term health outcomes for both mother and child. LEVEL OF EVIDENCE 3 Laryngoscope, 134:973-976, 2024.
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Affiliation(s)
- Hannah Klatzkow
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Sarah Gitomer
- Children's Hospital Colorado - Otolaryngology, Aurora, Colorado, U.S.A
| | | | - Melissa Anne Scholes
- University of Mississippi Medical Center - Otolaryngology, Jackson, Mississippi, U.S.A
| | - Emily Cooper
- University of Colorado - Anschutz Medical Campus, Aurora, Colorado, U.S.A
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Dabbous H, Chorney SR, Johnson RF, Kou YF. Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty. Laryngoscope 2024; 134:963-967. [PMID: 37458330 DOI: 10.1002/lary.30875] [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] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES To determine how initial postoperative airway endoscopy findings after stent removal predict successful decannulation in children undergoing double-staged laryngotracheoplasty (dsLTP). Secondary objectives assessed timing of decannulation and number of endoscopic interventions needed after dsLTP. METHODS A case series with chart review included children who underwent dsLTP at a tertiary children's hospital between 2008 and 2021. Rates of decannulation, time to decannulation, and number of interventions after dsLTP were recorded for children with high- or low-grade stenosis at the first bronchoscopy after stent removal. RESULTS Of the 65 children who were included, 88% had high-grade stenosis and 98% had a preoperative tracheostomy. Successful decannulation happened in 74% of the children, and 44% of the children were decannulated within 12 months of surgery. For children with low-grade stenosis at the first endoscopy after stent removal, 84% were successfully decannulated compared with 36% of the children with high-grade stenosis (p = 0.001). After dsLTP, children with high-grade stenosis required 7.5 interventions (SD: 3.3) compared with 4.0 interventions (SD: 3.0) for children with low-grade stenosis (p < 0.001). Decannulated children with high-grade stenosis necessitated more endoscopic procedures (7.0 vs. 3.7, p = 0.02). Time to decannulation was similar between children with high- and low-grade early postoperative stenosis (21.9 vs. 17.8 months, p = 0.63). CONCLUSIONS Higher grade stenosis identified on the first airway endoscopy after suprastomal stent removal is correlated with lower decannulation rates and more postoperative endoscopic interventions. Although time to decannulation was not impacted by early stenosis grade, surgeons might utilize these early airway findings to counsel families and prognosticate possible surgical success. LEVEL OF EVIDENCE 4 Laryngoscope, 134:963-967, 2024.
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Affiliation(s)
- Helene Dabbous
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen R Chorney
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Yann-Fuu Kou
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA
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Gagnon C, Bérubé S, Sauthier M, Rouillard-Bazinet N, Bergeron M. Evaluating the Need for Intensive Care Admission After Supraglottoplasty for Severe Laryngomalacia. Laryngoscope 2024; 134:466-470. [PMID: 37334868 DOI: 10.1002/lary.30813] [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] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Postoperative airway concerns persist despite a low rate of post-supraglottoplasty complications for children with laryngomalacia. The objective of this study is to determine the factors associated with the need for intensive care unit (ICU) admission following supraglottoplasty. METHODS A 7-year retrospective cohort analysis was conducted between 2014 and 2021. A patient requiring ICU level of care was defined as the use of respiratory support such as intubation, positive pressure ventilation, high-flow nasal cannula, or multiple doses of nebulized epinephrine. RESULTS About 134 medical charts were reviewed; 12 patients were excluded because of concurrent surgery. Age at the time of surgery was 2.8 (4.3) months (median [interquartile range]). About 33 (27.0%) ultimately required ICU-level care. Prematurity (odds ratio [OR] 13.8), neurological condition (OR ∞), American Society of Anesthesiology class 3-4 (OR 6.5), and younger age (OR 1.8) were more likely to require ICU admission. No patient above 10 months of age needed ICU monitoring. The use of respiratory support justifying ICU was known within the first 4 h after surgery for almost all (32/33, 97%) of these patients. 4/33 (12.1%) were kept intubated and the remaining needed non-invasive ventilation. Only one patient (1/122, 0.8%) was reintubated 12 h after surgery for progressive respiratory distress. CONCLUSION Approximately a quarter of patients required ICU-level care after supraglottoplasty. For nearly all patients without comorbidities requiring ICU, this can be safely predicted within the first 4 h after surgery. Our data suggest that selected patients undergoing supraglottoplasty may be safely monitored outside of an ICU setting after an observation period in the post-anesthesia care unit. LEVEL OF EVIDENCE 4 Laryngoscope, 134:466-470, 2024.
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Affiliation(s)
- Carolanne Gagnon
- Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Ste-Justine, Montreal, Quebec, Canada
| | - Simon Bérubé
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Michaël Sauthier
- Department of Pediatrics, Pediatric Intensive Care Unit, CHU Ste-Justine, Montreal, Quebec, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Noémie Rouillard-Bazinet
- Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Ste-Justine, Montreal, Quebec, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Mathieu Bergeron
- Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Ste-Justine, Montreal, Quebec, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
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5
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Favre NM, Powers KF, Viola FC, Carr MM. Foreign Body Aspiration Complicated by Pneumothorax in Children: HCUP-KID Perspective. Ann Otol Rhinol Laryngol 2023; 132:1222-1227. [PMID: 36582149 DOI: 10.1177/00034894221140775] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Children with airway foreign bodies (AFB) occasionally have pneumothorax complicating their course. We aimed to compare the clinical course of these children to those without this complication. METHODS Data was obtained from the 2016 Kids' Inpatient Database of Healthcare Cost Utilization Project. ICD-10 code of T17XXXX was used to locate records. They were grouped based on the presence of preoperative pneumothorax, postoperative pneumothorax, or none. Variables included demographics, AFB type, AFB location, length of stay (LOS), pneumothorax treatment modality, mortality, hospital setting, primary payor, and total charges. RESULTS A total of 4165 children with AFB were identified, 57.8% male and 42.2% female. Of these 75 (1.8%) patients presented with preoperative pneumothorax, 29 (0.7%) with postoperative pneumothorax, and 4061 (97.5%) with no pneumothorax. The preoperative pneumothorax patients were older than the postoperative pneumothorax and unaffected AFB patients (mean age = 9.5 [95% CI 7.7-11.3] vs 8.2 [95% CI 5.4-11.1] vs 5.5 [95% CI 5.3-5.7]; P < .001). Preoperative pneumothorax patients incurred higher total charges than the other groups (mean US = $939K [95% Cl 673K-1,204K] vs $599K [95% Cl 377K-821K] vs $228K [95% Cl 211K-244K]; P < .001), had a longer LOS in days (mean = 37.7 [95% Cl 28.7-46.7] vs 31.6 [95% Cl 16.9-46.2] vs 15.8 [95% CI 15.0-16.7]; P < .001), and had a higher mortality rate (16% vs 0% vs 3.7%, P < .001). CONCLUSION Pneumothorax can significantly impact a child's hospital course, and preoperative pneumothorax should alert clinicians to the potential for increased mortality risk.
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Affiliation(s)
- Nicole M Favre
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Kristina F Powers
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Francesca C Viola
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
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Kennedy DG, Wilson NR, Mwaura A, Carnino JM, Levi J. An Analysis of Laryngomalacia and Its Interplay With Obesity and Obstructive Sleep Apnea in Pediatric Inpatients. Cureus 2023; 15:e45313. [PMID: 37846256 PMCID: PMC10577003 DOI: 10.7759/cureus.45313] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/18/2023] Open
Abstract
Objective This study aimed to investigate the potential relationship between laryngomalacia and obesity as well as explore the interplay between laryngomalacia and obstructive sleep apnea using the Kids' Inpatient Database (KID) for the year 2016. Methods The Healthcare Cost and Utilization Project (HCUP) KID for 2016 provided a dataset for analysis. Patient demographics, diagnoses, and hospital characteristics were considered. Patients less than three years old were included due to the high prevalence of laryngomalacia in this age group. Results Among 4,512,196 neonatal admissions, 1,341 obesity cases and 11,642 laryngomalacia cases were analyzed. The frequency of laryngomalacia in patients with obesity was 578.1% higher than in the general population. Patients with obstructive sleep apnea (OSA) exhibited a 5,243.2% increase in laryngomalacia frequency compared to the overall population. Combining obesity and laryngomalacia resulted in a 6,738.5% increase in OSA frequency. Conclusions This study identified a significant correlation between obesity and increased laryngomalacia risk. The findings have important clinical implications for pediatric care, emphasizing the need to prevent childhood obesity to reduce laryngomalacia risk. Additionally, understanding these risk factors enables better risk stratification for laryngomalacia and potential OSA development.
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Affiliation(s)
- Dean G Kennedy
- Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, USA
| | - Nicholas R Wilson
- Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, USA
| | - Amos Mwaura
- Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, USA
| | - Jonathan M Carnino
- Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, USA
| | - Jessica Levi
- Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, USA
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Boyle S, Fitzsimons M, Heffernan C. In Reference to Documentation in Pediatric Microlaryngoscopy/Bronchoscopy. Laryngoscope 2023; 133:E26. [PMID: 36458664 DOI: 10.1002/lary.30500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Seamus Boyle
- ENT Department, Temple Street Hospital, Dublin, Ireland
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Neocleous P, Strychowsky JE, You P, Husein M, Nguyen LHP, Propst E, Wolter N, Graham ME. In Response to Documentation in Pediatric Microlaryngoscopy/Bronchoscopy. Laryngoscope 2023; 133:E27-E28. [PMID: 36458665 DOI: 10.1002/lary.30502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Penelope Neocleous
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Julie E Strychowsky
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Peng You
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Murad Husein
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Evan Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - M Elise Graham
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, London, Ontario, Canada
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Kumar KR, Soni L, Sinha R, Muthiah T, Patel N, Shende DK, Subramaniam R. Comparison of Ambu AuraGain and BlockBuster laryngeal mask for controlled ventilation in children undergoing minor surgical procedures under general anesthesia: A prospective randomized controlled study. Paediatr Anaesth 2023; 33:474-480. [PMID: 36866955 DOI: 10.1111/pan.14653] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Ambu AuraGain has proven to be better compared with other supraglottic airway devices in terms of higher first-attempt insertion success rate, time and ease of insertion, high oropharyngeal leak pressure, and fewer complications in children. The performance of the BlockBuster laryngeal mask has not been evaluated in children. AIMS The primary objective of this study was to compare the oropharyngeal leak pressure of the BlockBuster laryngeal mask with those of the Ambu AuraGain during controlled ventilation in children. METHODS Fifty children aged 6 months to 12 years with normal airways were randomized into group A (Ambu AuraGain) and group B (BlockBuster laryngeal mask). After administration of general anesthesia, an appropriate size supraglottic airway (size 1.5/2.0/2.5) was inserted according to the groups. Oropharyngeal leak pressure, success and ease of supraglottic airway insertion, gastric tube insertion, and ventilatory parameters were noted. The glottic view was graded by fiberoptic bronchoscopy. RESULTS Demographic parameters were comparable. The mean oropharyngeal leak pressure in the BlockBuster group (24.72 ± 6.81 cm H2 O) was significantly higher than Ambu AuraGain group (17.20 ± 4.28 cm H2 O) by 7.52 cm H2 O (95% CI 4.27 to 10.76; p = 0.001). The mean time for supraglottic airway insertion in the BlockBuster and Ambu AuraGain group was 12.04 ± 2.55 s and 13.64 ± 2.76 s, respectively (mean difference- 1.6 s, 95% CI 0.09-3.12; p = 0.04). Ventilatory parameters, first-attempt supraglottic airway insertion success rate, and ease of gastric tube insertion were comparable between the groups. The BlockBuster group showed easy supraglottic airway insertion compared with the Ambu AuraGain group. The BlockBuster group had better glottic views with only the larynx seen in 23 out of 25 children compared to the Ambu AuraGain with only the larynx seen in 19 out of 25 children. No complication was noted in either group. CONCLUSIONS We found that the BlockBuster laryngeal mask has higher oropharyngeal leak pressure compared with Ambu AuraGain in a pediatric population.
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Affiliation(s)
- Kanil Ranjith Kumar
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Lipika Soni
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Sinha
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Thilaka Muthiah
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nishant Patel
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dilip K Shende
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeshwari Subramaniam
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Powers KF, Reese AD, Carr MM. Pediatric Bronchoscopy for Airway Foreign Bodies in the ACS NSQIP-P: Morbidity and Mortality 2014-2019. Laryngoscope 2023; 133:689-693. [PMID: 35543238 DOI: 10.1002/lary.30170] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/04/2022] [Accepted: 04/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Examine morbidity and mortality associated with bronchoscopy for pediatric airway foreign body (AFB). Identify factors associated with adverse events. METHODS A retrospective analysis from 2014 to 2019 using the multicenter public data set from the American College of Surgeons National Surgical Quality Improvement Program- Pediatric. Patients under 18 who underwent bronchoscopy for AFB were identified. Demographics, comorbidities, perioperative events, length of stay, and complications were collected. Regression analysis was used to identify factors associated with adverse events. RESULTS 2302 patients were included; 1427 (62%) males and 875 (38%) females. Mean age was 3.9 years. (95% CI 3.7-4.1). 2025 (88%) retained AFB as the postoperative diagnosis. Comorbidities included structural pulmonary abnormalities in 234 (10.5%), asthma in 149 (6.5%), and impaired cognitive status in 134 (5.8%). Most common complications were pneumonia in 19 (0.8%) and reintubation in 10 (0.4%). 10 (0.4%) had a prolonged LOS >30 days. Nine (0.4%) children died within 30 days of surgery; 7 (78%) were ventilated and 6 (67%) had CPR prior to surgery. 18 (0.8%) returned to OR and 15 (0.7%) were readmitted for related reasons. Linear regression showed an association between ASA class (β = 0.708, p < 0.001), operative time (β = 0.015, p = 0.013) and reintubation (β = 10.5, p < 0.001) with LOS. Time in the OR was associated with return to OR (β = .008, p = 0.004) through logistic regression. CONCLUSION Morbidity is low in children with AFB and mortality is usually associated with preoperative lifesaving maneuvers. LEVEL OF EVIDENCE 4 Laryngoscope, 133:689-693, 2023.
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Affiliation(s)
- Kristina F Powers
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
| | - Alyssa D Reese
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
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Kim M, Park H, Kwon SK. Case of impacted subglottic metallic foreign body removal without tracheostomy through an endotracheal tube. Clin Case Rep 2022; 10:e05770. [PMID: 35521046 PMCID: PMC9066741 DOI: 10.1002/ccr3.5770] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022] Open
Abstract
A foreign body in the upper airway can cause serious morbidity and mortality, especially in pediatric patients. This case report describes an innovative way to remove an impacted foreign body distal to the vocal folds through an endotracheal tube without tracheostomy.
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Affiliation(s)
- Minju Kim
- Department of Otorhinolaryngology - Head and Neck Surgery Seoul National University Hospital Seoul National University College of Medicine Seoul Korea
| | - Haechan Park
- Department of Otorhinolaryngology - Head and Neck Surgery Seoul National University Hospital Seoul National University College of Medicine Seoul Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology - Head and Neck Surgery Seoul National University Hospital Seoul National University College of Medicine Seoul Korea
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12
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Gorostidi F, Glasson N, Salati V, Sandu K. Pediatric vascular anomalies with airway compromise. J Oral Pathol Med 2022; 51:888-896. [PMID: 35347777 PMCID: PMC10084185 DOI: 10.1111/jop.13297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/21/2021] [Accepted: 01/08/2022] [Indexed: 11/27/2022]
Abstract
Vascular anomalies are rare lesions of diverse nature that may affect the head and neck region. Any mass in or around the upper airway has the potential to obstruct or compromise it. The absolute priority, before etiologic treatment, is the evaluation of the risk for the airway and its management. Prenatal diagnosis of an upper airway obstruction requires a planned delivery in a center having a specialized team experienced in managing a compromised feto-neonatal airway, and who could perform an ex-utero intrapartum treatment to secure the airway. Even after birth, the airway remains central in the patient's overall management. Signs and symptoms of airway compromise must be evaluated keeping in mind the specific requirements of infants and small children and being aware that rapid worsening may occur. The treatment is then tailored to the patient and his lesion with the goal of improving symptoms while avoiding treatment-related complications. Maintaining reasonable expectations by the patient and families are part of a successful management. Cure is achievable for small and localized lesions, but symptom relief and mitigation of functional, esthetic and psychological impairments is the goal for large and complex lesions. If a tracheotomy was required, decannulation is one of the primary management goals.
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Affiliation(s)
- François Gorostidi
- Department of Otolaryngology and Head Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Nicolas Glasson
- Department of Otolaryngology and Head Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Victoria Salati
- Department of Otolaryngology and Head Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Kishore Sandu
- Department of Otolaryngology and Head Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Sequera-Ramos L, Garcia-Marcinkiewicz A, Riva T, Fuchs A. Noninvasive ventilation in children: A review for the pediatric anesthesiologist. Paediatr Anaesth 2022; 32:262-272. [PMID: 34877751 DOI: 10.1111/pan.14364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/15/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 01/19/2023]
Abstract
Preserving adequate respiratory function is essential in the perioperative period. Mechanical ventilation with endotracheal intubation is widely used for this purpose. In select patients, noninvasive ventilation (NIV) may be an alternative to invasive ventilation or may complement respiratory management. NIV is used to provide ventilatory support and increase gas exchange at the alveolar level without the use of an invasive artificial airway such as an endotracheal tube or tracheostomy. NIV includes both continuous positive airway pressure (CPAP) and noninvasive positive pressure ventilation. Indications for NIV range from acute hypoxic respiratory failure in the intensive care unit or the emergency department, to chronic respiratory failure in patients with neuromuscular disease with nocturnal hypoventilation. In the perioperative setting, NIV is commonly applied as CPAP, and bilevel positive airway pressure (BPAP). There are limited data on the role of NIV in children in the perioperative setting, and there are no clear guidelines regarding optimal timing of use and pressure settings of perioperative NIV. Contraindications to the use of NIV include reduced level of consciousness, apnea, severe respiratory distress, and inability to maintain upper airway patency or airway protective reflexes. Common problems encountered during NIV involve airway leaks and asynchrony with auto-triggering. High-flow nasal oxygen (HFNO) has emerged as an alternative to NIV when trying to decrease the work of breathing and improve oxygenation in children. HFNO delivers humidified and heated oxygen at rates between 2 and 70 L/min using specific nasal cannulas, and flows are determined by the patient's weight and clinical needs. HFNO can be useful as a method for preoxygenation in infants and children by prolonging apnea time before desaturation, yet in children with decreased minute ventilation or apnea HFNO does not improve alveolar gas exchange. Clinicians experienced with these devices, such as pediatric intensivists and pulmonary medicine specialists, can be useful resources for the pediatric anesthesiologist caring for complex patients on NIV.
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Affiliation(s)
- Luis Sequera-Ramos
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Annery Garcia-Marcinkiewicz
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Unit for Research & Innovation in Anaesthesia, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy
| | - Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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14
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Beatrix Christina Kokje V, Ishii A, Sandu K. Moderate grade subglottic stenosis in children: Laryngotracheal reconstruction versus cricotracheal resection and anastomosis. Front Pediatr 2022; 10:914892. [PMID: 35967556 PMCID: PMC9366050 DOI: 10.3389/fped.2022.914892] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The surgical treatment of choice of pediatric moderate subglottic stenosis (major grade II and minor grade III SGS or 60-80% lumen obstruction) remains controversial. Laryngotracheal reconstruction (LTR) (with anterior ± posterior grafts for airway expansion) and partial crico-tracheal resection (PCTR) are the mainly described open surgical techniques. We reviewed our pediatric cases with moderate subglottic stenosis to determine the efficacy of LTR versus PCTR. METHODS A retrospective study of all children between 0 and 18 years that underwent open reconstructive airway surgery between 2012 and 2019. Children who had either acquired or congenital moderate subglottic stenosis (late grade II and early grade III: 60-80% lumen obstruction) were selected. RESULTS Twenty-six children with moderate-grade subglottic stenosis were included. Seventeen were treated with LTR and nine with PCTR. No significant differences were observed between LTR and PCTR-treated cases. Decannulation rates were similar, as well as the functional results. CONCLUSION Both LTR and PCTR are valid treatment options for moderate subglottic stenosis. This study indicates to perform the surgery that is most suitable for the characteristics of the patients' stenosis, the surgeons' expertise and preference, and the working infrastructure.
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Affiliation(s)
| | | | - Kishore Sandu
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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15
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Veroul E, Amaddeo A, Leboulanger N, Gelin M, Denoyelle F, Thierry B, Fauroux B, Luscan R. Noninvasive Respiratory Support as an Alternative to Tracheostomy in Severe Laryngomalacia. Laryngoscope 2021; 132:1861-1868. [PMID: 34713900 DOI: 10.1002/lary.29928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/12/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To analyze the role of noninvasive respiratory support (NRS) as an alternative to tracheostomy in the management of severe laryngomalacia. STUDY DESIGN We conducted a monocentric retrospective study in a tertiary pediatric care center. METHODS All children under the age of 3 years with severe laryngomalacia, treated between January 2014 and December 2019, were included. Patient demographics, medical history, nutrition, surgery, NRS, and outcome were reviewed. Predictors for NRS were analyzed. RESULTS One hundred and eighty-eight patients were included. Mean age was 4 ± 5 months and mean weight was 4,925 ± 1,933 g. An endoscopic bilateral supraglottoplasty was performed in 183 (97%) patients and successful in 159 (87%). NRS was initiated in 29 (15%) patients at a mean age of 3 ± 2 months (1-11 months): 15 (52%) patients were treated with NRS after surgical failure, 9 (31%) were treated with NRS initiated prior to surgery because of abnormal overnight gas exchange, and 5 (17%) were treated exclusively with NRS due to comorbidities contraindicating an endoscopic procedure. NRS was successfully performed in all patients with a mean duration of 6 ± 11 months. No patient required a tracheostomy. Univariate analysis identified the following predictors of NRS: neonatal respiratory distress (P = .003), neurological comorbidity (P < .001), associated laryngeal abnormality (P < .001), cardiac surgery (P = .039), surgical endoscopic revision (P = .007), and nutritional support (P < .001). CONCLUSION NRS is a safe procedure, which may avoid a tracheostomy in severe laryngomalacia, in particular, in case of endoscopic surgery failure, respiratory failure before surgery, and/or severe co-morbidity. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Elina Veroul
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Alessandro Amaddeo
- Faculté de Médecine, Université de Paris, Paris, France.,Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France.,Institut Mondor pour la Recherche Biomédicale, INSERM U955 Team 13, Creteil, France
| | - Matthieu Gelin
- Université de Paris, Human Immunology Pathophysiology Immunotherapy (HIPI), CytoMorpho Lab, INSERM CEA UMR976, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Briac Thierry
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Brigitte Fauroux
- Faculté de Médecine, Université de Paris, Paris, France.,EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Université de Paris, Paris, France
| | - Romain Luscan
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
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16
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Wani TM, John J, Bahun V, AlGhamdi F, Tumin D, Tobias JD. Endotracheal tube cuff position in relation to the cricoid in children: A retrospective computed tomography-based analysis. Saudi J Anaesth 2021; 15:403-408. [PMID: 34658727 PMCID: PMC8477782 DOI: 10.4103/sja.sja_396_21] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022] Open
Abstract
Background: The use of cuffed endotracheal tubes (ETT) has become the standard of care in pediatric practice. The rationale for the use of a cuffed ETT is to minimize pressure around the cricoid while providing an effective airway seal. However, safe care requires that the cuff lie distal to the cricoid ring following endotracheal intubation. The current study demonstrates the capability of computed tomography (CT) imaging in identifying the position of the cuff of the ETT in intubated patients. Methods: In this retrospective study, the ETT cuff position was examined on the sagittal plane images of neck and chest CT scans of 44 children. The position of the proximal and the distal aspect of the ETT cuff inside the trachea was recorded in relation to the vertebral levels. The vertebral levels were used to estimate the location of the cricoid ring and its relationship to the cuff. Results: The vertebrae were used as the primary landmarks to define the position of the cricoid and its relationship to the cuff of the ETT. Correlating vertebral levels with the cricoid for different age groups, the proximal (cephalad) edge of the ETT cuff was below the cricoid in 41 of 44 patients (93%). The ETT cuff was deep in 6 patients, below the 1st thoracic vertebra, with 2 ETTs in the right mainstem bronchus. Conclusion: This is the first study demonstrating that the cuff of the ETT and its position in the trachea can be identified on CT imaging in children. The ETT cuff was below the level of the cricoid in the majority of patients irrespective of the patient's age as well as the size, make, and type of ETT.
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Affiliation(s)
- Tariq M Wani
- Department of Anesthesiology, Sidra Medicine, Doha, Qatar
| | - Jiju John
- Department of Anesthesiology, Sidra Medicine, Doha, Qatar
| | | | - Faris AlGhamdi
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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17
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Taylor A, Menon S, Grant P, Currie B, Soma M. Traumatic Pediatric Tracheal Rupture After Blunt Force Sporting Injury: Case Report and Review of the Literature. Ann Otol Rhinol Laryngol 2021; 131:923-927. [PMID: 34541893 DOI: 10.1177/00034894211046707] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This paper presents the case of a traumatic tracheal rupture in a pediatric patient. The body of literature of the clinical features, evaluation, and management of this uncommon presentation is discussed. CASE A 13-year-old boy sustained an intrathoracic tracheal rupture whilst playing Australian Rules football. He developed hallmark clinical features of air extravasation and was intubated prior to transfer to a tertiary pediatric center for further management. After a short trial of conservative management, his respiratory status deteriorated and he was taken to the operating theater for open surgical repair of the defect. CONCLUSION Traumatic rupture of the trachea is a rare injury in children. This case demonstrates the dynamic nature of this serious injury and the need for multidisciplinary care in achieving the optimal outcome.
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Affiliation(s)
- Alon Taylor
- Department of Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Seema Menon
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Peter Grant
- Department of Cardiothoracic Surgery, Sydney Children's Hospital, Randwick, NSW, Australia.,Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Bruce Currie
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Marlene Soma
- Department of Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
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18
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Owusu-Bediako K, Turner H, Syed O, Tobias J. Options for Intraoperative Repair of a Cut Pilot Balloon on the Endotracheal Tube. Med Devices (Auckl) 2021; 14:265-269. [PMID: 34512044 PMCID: PMC8423496 DOI: 10.2147/mder.s323982] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/20/2021] [Indexed: 12/27/2022] Open
Abstract
Severing of the pilot balloon of an endotracheal tube (ETT) results in cuff deflation and may lead to complications including inadequate patient ventilation, increased risk of aspiration and infection, and operating room air pollution with anesthetic gases. In situations where ETT exchange or reintubation may pose a significant risk to the patient, temporary repair of the severed cuff tubing can be helpful until it is safe to address the problem with replacing the ETT. Simple and effective repair methods can be achieved using readily available materials in the operating room, including intravenous cannulas, hypodermic syringes, and epidural clamp connectors. However, choosing which technique or method depends mainly on personal preference, equipment availability, and provider comfort and experience. We present a 12-year-old adolescent who presented for anesthetic care for extensive burn injury. During removal of the dressing around the head and face, the tubing of the pilot balloon of the ETT was inadvertently cut. Options for dealing with such problems are discussed, including techniques to allow for temporary repair and re-inflation of the deflated cuff.
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Affiliation(s)
- Kwaku Owusu-Bediako
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Henry Turner
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Omar Syed
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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19
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Gardner JR, Navuluri S, Small M, Richter GT. Superabsorbent Gel Polymer Aspiration and Erosion Into Mediastinum. OTO Open 2021; 5:2473974X211023020. [PMID: 34179679 PMCID: PMC8202283 DOI: 10.1177/2473974x211023020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- James Reed Gardner
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sriram Navuluri
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mariah Small
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Gresham Thomas Richter
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
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20
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Bergeron M, Giliberto JP, Tabangin ME, de Alarcon A. Vocal Fold Injection Augmentation for Post-Airway Reconstruction Dysphonia: A Case Series. Ann Otol Rhinol Laryngol 2021:34894211012594. [PMID: 33949216 DOI: 10.1177/00034894211012594] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Post airway reconstruction dysphonia (PARD) is common and has a significant effect on the quality of life of patients. Vocal fold injection augmentation (VFIA) is one treatment that can be used to improve glottic insufficiency in some patients. The goal of this study was to characterize the use and outcomes of VFIA for PARD. METHODS Retrospective chart review from January 2007 to July 2018 at a tertiary pediatric care center. Consecutive patients with PARD who underwent VFIA, who had a preoperative voice evaluation and a follow-up evaluation within 3 months after VFIA (fat, carboxymethylcellulose gel, hyaluronic acid). RESULTS Thirty-four patients (20 female) underwent VFIA. The mean age at the time of the injection was 13.6 years (SD 6.1). Twenty patients (58.8%) had a history of prematurity and a mean of 1.8 open airway surgeries. After injection, 29/34 patients (85.3%) noted a subjective voice improvement. The baseline Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) overall severity score decreased by a mean of 5.7 (SD = 19.6) points, P = .12. Total pediatric Voice Handicap Index (pVHI) improved by 6.0 (SD = 19.5) points, from 57.4 (SD = 20.0) to 51.4 (SD = 17.2), P = .09. Functional pVHI subscore demonstrated a significant improvement, with a decrease of 3.4 (SD = 7.3) points, P = .02. All procedures were performed as an overnight observation and no complication occurred. CONCLUSION Patients with PARD represent a complex subset of patients. VFIA is a straightforward intervention that may improve voice perception. Many patients reported subjective improvement despite minimal objective measurement. Further work is warranted to elucidate the role of injection in management of PARD.
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Affiliation(s)
- Mathieu Bergeron
- Department of Pediatric Otolaryngology, CHU Sainte-Justine, Montreal, QC, Canada
| | - John Paul Giliberto
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
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21
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Voulgarelis S, Stucke A. Retrieving multiple magnetic foreign bodies from the glottic entrance and stomach: A case report. Saudi J Anaesth 2021; 15:56-58. [PMID: 33824646 PMCID: PMC8016056 DOI: 10.4103/sja.sja_867_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/02/2022] Open
Abstract
Aspiration and ingestion of foreign bodies present a frequent challenge in pediatric anesthesia practice that requires careful planning of the time and the method of retrieval. We discuss the management of a 20-month-old boy who had ingested multiple small magnetic beads and presented emergently to the operating room with two beads lodged in the vallecula and eighteen more forming a chain in the stomach. Benefitting from their magnetic properties, the beads located close to the glottic entrance could be removed by placing a steel Magill forceps close to the objects and using magnetic pull rather than grasping. The beads in the stomach were removed en bloc due to their magnetic properties using an endoscopic retrieval basket. Small beads can be difficult to remove, however, in this case it was possible to utilize their magnetic properties during the removal process.
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Affiliation(s)
- Stylianos Voulgarelis
- Department of Anesthesiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Astrid Stucke
- Department of Anesthesiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
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22
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Mott N, Kang Y, Bruch S, Heider A, Thatcher A. Well-Differentiated Thyroid Cancer Invading the Trachea in a Pediatric Patient. AACE Clin Case Rep 2021; 7:207-210. [PMID: 34095490 PMCID: PMC8165114 DOI: 10.1016/j.aace.2021.01.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Pediatric thyroid cancer is rare. Most cases are well-differentiated thyroid cancers (WDTCs). However, gross laryngotracheal invasion of WDTCs is unusual. This report details the first case in English medical literature of a pediatric WDTC invading the trachea. Methods Thyroid stimulating hormone, free triiodothyronine, free thyroxine, thyroglobulin, parathyroid hormone, calcitonin, thyroglobulin antibody, chest magnetic resonance imaging, neck ultrasound, neck computed tomography, and fine needle aspiration were performed. Results A 9-year-old boy with moderate persistent asthma presented with increasing upper respiratory symptoms. Spirometry suggested a fixed upper airway obstruction. Chest x-ray revealed a left tracheal shift, and chest magnetic resonance imaging identified a right thyroid mass. Thyroglobulin level was 809 ng/mL (normal, ≤33 ng/mL). Results of thyroid stimulating hormone, free triiodothyronine, free thyroxine, parathyroid hormone, calcitonin, and thyroglobulin antibody were normal. Neck ultrasound revealed 2 right thyroid lobe nodules. Neck computed tomography revealed tracheal compression. Fine needle aspiration of the largest nodule yielded atypia of undetermined significance. Bronchoscopy findings at his local hospital were concerning for tracheal invasion. He underwent total thyroidectomy, cricotracheal resection, reconstruction, and radioactive iodine therapy (220 mCi). Pathology demonstrated a well-differentiated papillary thyroid carcinoma without solid or diffuse sclerosing subtype components. Tumor cytogenetic and single nucleotide polymorphism microarray studies showed normal findings. One year postoperatively, neck ultrasound demonstrated no recurrence, and thyroglobulin levels were undetectable while on levothyroxine therapy. Conclusion Pediatric WDTC invading the trachea has not been reported.
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Affiliation(s)
- Nicole Mott
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Yena Kang
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Steven Bruch
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
| | - Amer Heider
- University of Michigan, Department of Pathology, Ann Arbor, Michigan
| | - Aaron Thatcher
- University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, Michigan
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23
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Luitje M, Vandjelovic N, McKenna Benoit M, Faria J. Sublabial Approach for Repair of Congenital Nasal Pyriform Aperture Stenosis: How I Do It. Laryngoscope 2021; 131:2352-2355. [PMID: 33666258 DOI: 10.1002/lary.29472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/03/2021] [Accepted: 02/13/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Martha Luitje
- Department of Otolaryngology, University of Rochester, Rochester, New York, U.S.A
| | - Nathan Vandjelovic
- Department of Otolaryngology, University of Rochester, Rochester, New York, U.S.A
| | - Margo McKenna Benoit
- Department of Otolaryngology, University of Rochester, Rochester, New York, U.S.A
| | - John Faria
- Department of Otolaryngology, University of Rochester, Rochester, New York, U.S.A
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24
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Reed L, Larson S, Sheyn A, McLevy J. Removal of Airway Foreign Body in a Premature Neonate. Ann Otol Rhinol Laryngol 2021; 130:1198-1201. [PMID: 33660549 DOI: 10.1177/0003489421999536] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Airway foreign bodies are the leading cause of infantile deaths and fourth among preschool children. Airway foreign bodies in extremely premature neonates represent a rare but potentially lethal entity. There are very few reports in the literature describing the treatment of such a condition in premature neonates. The objectives of this report are to describe the safe removal of an airway foreign body in an extremely premature infant using urologic instruments in a trans-endotracheal tube fashion and to review the literature for other techniques that have proven safe and effective, thereby adding technical options for future cases. METHODS We reviewed the case reported and reviewed pertinent literature. RESULTS A 2-week old, ex-24 3/7-week, 820-g pre-mature infant was intubated with a 2.5 endotracheal tube. After intubation, a 2-cm foreign body was discovered in the distal trachea by chest x-ray. The child's respiratory status continuously deteriorated with increasing oxygen and positive pressure requirements. While remaining intubated, the child underwent direct suspension laryngoscopy, the ventilator circuitry was disconnected, and the object was successfully removed using a 1.2 mm rigid ureteroscope and 1.1 mm grasping forceps through the 2.5 endotracheal tube. CONCLUSION This case report demonstrates the effectiveness of using a 1.2 mm ureteroscope and 1.2 mm urologic graspers to extract an airway foreign body from an extremely premature neonate through an endotracheal tube without paralyzing the patient. This method provides a safe and effective means of visualizing and, if necessary, manipulating the airway in a population prone to respiratory complications.
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Affiliation(s)
- Leighton Reed
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephen Larson
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony Sheyn
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer McLevy
- Department of Otolaryngology, Head & Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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25
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Moser B, Kemper M, Dullenkopf A, Dave MH, Buehler PK, Weiss M. Simulated dimensional compatibility of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children. Paediatr Anaesth 2021; 31:167-177. [PMID: 33128267 DOI: 10.1111/pan.14058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/17/2020] [Revised: 09/30/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cuffed tracheal tubes have recently been recommended for selective endobronchial intubation to establish single-lung ventilation even in smaller children. This implies that, compared with uncuffed tracheal tubes, the cuffed tracheal tubes selected will be smaller and therefore have a shorter length. We hypothesized that cuffed tracheal tubes might be of insufficient length for selective endobronchial intubation if the tube cuff were fully immersed in the left or right mainstem bronchus. METHODS The distance from the proximal end of the tracheal tube to the upper border of the cuff in cuffed tracheal tubes and to the upper margin of the Murphy eye in uncuffed tracheal tubes, respectively, was assessed in sizes 3.0-7.0 mm internal diameter. The raw data sets of two previously performed studies obtained from 337 children aged from birth to 16 years, including the distances "teeth to tracheal tube tip" and "tracheal tube tip to carina," were used to calculate age-, weight-, and height-related data for the distance from "teeth to carina." Tracheal tube dimensions were compared with age-related distances from "teeth to carina," applying published recommendations for the selection of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children. RESULTS The differences between the length of the age-related tracheal tube and the tracheal tube insertion length required to guarantee full insertion of the tracheal tube cuff or the Murphy eye within the mainstem bronchus ranged from -3.5 to 52.6 mm in cuffed tracheal tubes and from 42.3 to 83.3 mm in uncuffed tracheal tubes. CONCLUSIONS For many age groups of patients requiring selective endobronchial intubation, the lengths of cuffed tracheal tubes, in contrast to those of uncuffed tracheal tubes, were revealed to be critically short for safe taping outside the oral cavity with the cuff placed completely within the right or left mainstem bronchus.
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Affiliation(s)
- Berthold Moser
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Anaesthesia and Intensive Care, Spital Limmattal, Schlieren, Switzerland
| | - Michael Kemper
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Alexander Dullenkopf
- Department of Anaesthesia and Intensive Care, Kantonsspital, Frauenfeld, Switzerland
| | - Mital H Dave
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Markus Weiss
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
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26
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Mudd P, Wikner E, Rana MS, Zalzal G. Presenting Symptom as a Predictor of Clinical course in Juvenile Onset Recurrent Respiratory Papillomatosis. Laryngoscope 2020; 131:1670-1675. [PMID: 33331659 DOI: 10.1002/lary.29327] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/HYPOTHESIS Determine if the presentation of voice versus airway symptoms at the time of diagnosis of juvenile recurrent respiratory papillomatosis (JORRP) correlates with treatment and outcomes. STUDY DESIGN Original report, Retrospective review. METHODS Twenty year retrospective review of all patients with JORRP presenting at any time in treatment to a single tertiary children's hospital between 1997 and 2017. RESULTS Fifty-four patients presented with a diagnosis of JORRP during the 20 year study period. Of these, 32 were female and 22 were male. African American children made up the majority of the patients (65%), with 19% identifying as Caucasian, 9% Hispanic, and 7% Asian. Fifteen of the children presented initially to the ENT clinic (87% with hoarseness), 12 to the emergency department (92% with airway concerns), 11 to the voice clinic, and the remaining 12 at outside hospitals or clinics and care were transferred. Voice symptoms, namely hoarseness, was the presenting symptom in 31 (57%), airway symptoms, namely respiratory distress or stridor was predominate in 17 (32%), and the presenting symptom was unknown in six cases (11%). Children presenting with airway symptoms were younger at presentation (median 2.1 years, range 0.38-8.77 years) than those presenting with voice symptoms (median 6.7 years, range 0.98-15.13 years), and after adjusting for age underwent a greater number of surgeries in the first year to control disease. CONCLUSIONS Patients who present with airway symptoms present younger and have an increased number of surgeries in the first year compared to those presenting with voice complaints. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1670-1675, 2021.
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Affiliation(s)
- Pamela Mudd
- Department of Pediatric Otolaryngology, Children's National Hospital, Washington, District of Columbia, U.S.A.,School of Medicine and Health Science, The George Washington University, Washington, District of Columbia, U.S.A
| | - Emily Wikner
- Department of Pediatric Otolaryngology, Children's National Hospital, Washington, District of Columbia, U.S.A.,School of Medicine and Health Science, The George Washington University, Washington, District of Columbia, U.S.A
| | - Md Sohel Rana
- Department of Pediatric Otolaryngology, Children's National Hospital, Washington, District of Columbia, U.S.A
| | - George Zalzal
- Department of Pediatric Otolaryngology, Children's National Hospital, Washington, District of Columbia, U.S.A.,School of Medicine and Health Science, The George Washington University, Washington, District of Columbia, U.S.A
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27
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Hall AC, Navaratnam AV, Maughan E, Hartley B, Hewitt RJ, Butler C. Endoscopic Multipoint Laser System for Objective Pediatric Airway Assessment. Otolaryngol Head Neck Surg 2020; 164:1354-1356. [PMID: 33076768 DOI: 10.1177/0194599820966302] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent technological advances within aeronautical engineering have demonstrated the delivery of objective quantitative endoscopic measurements to within one-hundredth of a millimeter. We sought to validate this emerging laser technology in a simulation-based assessment of pediatric airway stenosis. A 4.4-mm flexible endoscope, incorporating a laser measurement system projecting 49 laser points into the endoscopic view, was used to assess a simulated model of subglottic stenosis. Multiple anteroposterior and lateral measurements were obtained for each stenosis and compared with standard airway assessment techniques. Intra- and interobserver reliability was assessed. A total of 240 multipoint laser measurements were obtained of simulated airway stenosis. The mean difference from manual measurement was 0.1886 mm. The Bland-Altman plot showed low bias (0.011) and narrow 95% limits of agreement (-0.46 to 0.48). This advanced endoscopic measurement technique shows great promise for clinical development to benefit ongoing assessment and treatment of evolving pediatric airway stenosis.
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Affiliation(s)
| | | | - Elizabeth Maughan
- Great Ormond Street Hospital for Children, London, UK.,UCL Institute of Child Health, London, UK
| | | | | | - Colin Butler
- Great Ormond Street Hospital for Children, London, UK.,UCL Institute of Child Health, London, UK
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28
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Wistermayer P, Escalante D, McIlwain W, Rogers DJ. A Randomized Controlled Trial of Dexamethasone as a Prophylactic Treatment for Subglottic Stenosis in a Rabbit Model. Ann Otol Rhinol Laryngol 2020; 130:182-187. [PMID: 32749146 DOI: 10.1177/0003489420946773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Iatrogenic injury is a common cause of subglottic stenosis (SGS). We investigated the role of pre-injury dexamethasone as a preventive treatment for iatrogenic subglottic stenosis. METHODS 16 New Zealand White rabbits were used in an IACUC approved study. Subjects were divided into two groups: intramuscular dexamethasone (DEX) at a dose of 2 mg/kg 15 minutes prior to an endoscopic injury to create SGS, and the same injury creation with a preoperative intramuscular saline (SAL) injection. Three independent, blinded raters evaluated endoscopic images to obtain cross sectional area (CSA) airway measurements. Rabbit airways were measured just prior to injury and at one week post-injury. All subjects were provided as-needed postoperative steroids and buprenorphine for symptoms of respiratory distress. Data analysis was performed using Student t-test. Intraclass correlation coefficients were used to assess inter-rater agreement. RESULTS All subjects survived to the one-week post-injury airway evaluation. There was no difference in airway size between groups prior to injury (P = .28). Subjects in the DEX group demonstrated an average stenosis of 20.3% (95% CI 10.2-30.5) at one week compared to 60.6% (95% CI 40.3-80.9) in the SAL group (P = .01). Subjects in the control group required significantly more doses of postoperative dexamethasone (P = .02). Inter-rater agreement for between raters was excellent (ICC = .88). CONCLUSION This is the first study to examine the role of pre-injury glucocorticoids in preventing iatrogenic subglottic stenosis. In our model, a single dose of intramuscular dexamethasone given prior to a subglottic injury resulted in a statistically significant reduction in airway stenosis. This research suggests that administering systemic dexamethasone should be considered prior to any procedure that may injure the subglottis, including traumatic intubation, to prevent iatrogenic subglottic stenosis.
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Affiliation(s)
- Paul Wistermayer
- Primary Investigator, Resident Otolaryngology, Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Derek Escalante
- Associate Investigator, Resident Otolaryngology, Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Wesley McIlwain
- Associate Investigator, Otolaryngology, Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Derek J Rogers
- Senior Investigator, Pediatric Otolaryngology, Madigan Army Medical Center, Tacoma, WA, USA
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29
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Jayawardena ADL, Ghersin ZJ, Mirambeaux M, Bonilla JA, Quiñones E, Zablah E, Callans K, Hartnick M, Sahani N, Cayer M, Hersh C, Gallagher TQ, Yager PH, Hartnick CJ. A Sustainable and Scalable Multidisciplinary Airway Teaching Mission: The Operation Airway 10-Year Experience. Otolaryngol Head Neck Surg 2020; 163:971-978. [PMID: 32600113 DOI: 10.1177/0194599820935042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To address whether a multidisciplinary team of pediatric otolaryngologists, anesthesiologists, pediatric intensivists, speech-language pathologists, and nurses can achieve safe and sustainable surgical outcomes in low-resourced settings when conducting a pediatric airway surgical teaching mission that features a program of progressive autonomy. STUDY DESIGN Consecutive case series with chart review. SETTING This study reviews 14 consecutive missions from 2010 to 2019 in Ecuador, El Salvador, and the Dominican Republic. METHODS Demographic data, diagnostic and operative details, and operative outcomes were collected. A country's program met graduation criteria if its multidisciplinary team developed the ability to autonomously manage the preoperative huddle, operating room discussion and setup, operative procedure, and postoperative multidisciplinary pediatric intensive care unit and floor care decision making. This was assessed by direct observation and assessment of surgical outcomes. RESULTS A total of 135 procedures were performed on 90 patients in Ecuador (n = 24), the Dominican Republic (n = 51), and El Salvador (n = 39). Five patients required transport to the United States to receive quaternary-level care. Thirty-six laryngotracheal reconstructions were completed: 6 single-stage, 12 one-and-a-half-stage, and 18 double-stage cases. We achieved a decannulation rate of 82%. Two programs (Ecuador and the Dominican Republic) met graduation criteria and have become self-sufficient. No mortalities were recorded. CONCLUSION This is the largest longitudinal description of an airway reconstruction teaching mission in low- and middle-income countries. Airway reconstruction can be safe and effective in low-resourced settings with a thoughtful multidisciplinary team led by local champions.
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Affiliation(s)
- Asitha D L Jayawardena
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Zelda J Ghersin
- Pediatric Intensive Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcos Mirambeaux
- Department of Otolaryngology, Roberto Reid Cabral, Santa Domingo, Dominican Republic
| | - Jose A Bonilla
- Department of Otolaryngology, Benjamin Bloom Hospital, San Salvador, El Salvador
| | - Ernesto Quiñones
- Hospital de los Valles, Universidad San Francisco de Quito, Quito, Ecuador
| | - Evelyn Zablah
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Kevin Callans
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Marina Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Nita Sahani
- Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Makara Cayer
- Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Cheryl Hersh
- Pediatric Airway, Voice and Swallowing Center, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Thomas Q Gallagher
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Phoebe H Yager
- Pediatric Intensive Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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30
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Gupta M, Khan H, Gupta M. Bilateral Congenital Nasolacrimal Duct Cyst: A Rare Cause of Nasal Obstruction. Cureus 2020; 12:e8742. [PMID: 32714680 PMCID: PMC7377024 DOI: 10.7759/cureus.8742] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Nasal obstruction in neonates often results in respiratory discomfort, as neonates are obligate nasal breathers. Congenital bilateral nasal obstruction is an emergency situation which is generally secondary to choanal atresia. Rarely bilateral nasolacrimal duct (NLD) cyst causing intranasal swelling may be the underlying etiology. Neonatal respiratory distress warrants immediate measures to secure the airway and prompt investigations to reach a diagnosis for a definitive management. We describe a case of two-day-old girl with intermittent breathing difficulty because of bilateral NLD cysts causing nasal obstruction. The patient improved with conservative medical management.
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Affiliation(s)
- Manish Gupta
- Otorhinolaryngology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, IND
| | - Habibulla Khan
- Otorhinolaryngology, Maharishi Markandeshwar Institute of Medical Science and Research, Ambala, IND
| | - Monica Gupta
- General Medicine, Government Medical College and Hospital, Chandigarh, IND
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31
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Mokhtari TE, Miller LE, Jayawardena ADL, Sadow PM, Hardy SC, Rothman D, Hartnick CJ. Eosinophilic Granulomatosis With Polyangiitis: An Unusual Case of Pediatric Subglottic Stenosis. Laryngoscope 2020; 131:656-659. [PMID: 32562500 DOI: 10.1002/lary.28848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/01/2020] [Revised: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 12/27/2022]
Abstract
Systemic disease is an uncommon cause of subglottic stenosis (SGS). We report a case of severe SGS due to underlying eosinophilic granulomatosis with polyangiitis (EGPA) in a child presenting with isolated stridor. EGPA is a rare systemic vasculitis with very limited cases reported in the pediatric population. While surgical intervention was required given the degree of stenosis in this case, medical management of the underlying systemic disease process is critical when there is clinical suspicion of SGS in the context of systemic vasculitis. Laryngoscope, 131:656-659, 2021.
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Affiliation(s)
- Tara E Mokhtari
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Lauren E Miller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Asitha D L Jayawardena
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Peter M Sadow
- Department of Pathology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Stephen C Hardy
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Deborah Rothman
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
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32
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Jayawardena ADL, Romano S, Callans K, Fracchia MS, Hartnick CJ. Family-Centered Information Dissemination: A Multidisciplinary Virtual COVID-19 "Town Hall". Otolaryngol Head Neck Surg 2020; 163:929-930. [PMID: 32513062 DOI: 10.1177/0194599820935419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Significant misinformation about COVID-19 has been spread on the internet. Parents of children with complex aerodigestive problems have a hard time understanding the information they encounter on the internet and the news media and interpreting how it relates to their child's complex needs. Our multidisciplinary team, at the suggestion of a parent, hosted 3 virtual "town halls" in which families could ask questions directly of pediatric otolaryngology, pediatric pulmonology and case management in order to efficiently obtain factual evidence-based up-to-date advice. The information discussed at the town halls was then annotated and disseminated via active, parent-run aerodigestive social media forums. The information disseminated via the town halls reached 4787 Facebook participants.
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Affiliation(s)
- Asitha D L Jayawardena
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Sarah Romano
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Kevin Callans
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - M Shannon Fracchia
- Department of Pediatric Pulmonology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher J Hartnick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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33
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Yibrehu BA, Krakovsky GM, Rana MS, Pillai DK, Sehgal S, Collins ME, Gatti ML, Bauman NM. Pediatric Quality-of-Life Scores Following a Multidisciplinary Aerodigestive Team Approach to Manage Chronic Cough. Ann Otol Rhinol Laryngol 2020; 129:1088-1094. [PMID: 32486883 DOI: 10.1177/0003489420931558] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Chronic recalcitrant cough is present in 2/3 of pediatric patients evaluated in our tertiary-care multidisciplinary aerodigestive clinic (ADC). This study aimed to determine the impact of chronic cough and efficacy of ADC treatment using the validated Pediatric-Cough Quality-of-Life-27 tool (PC-QOL-27). METHODS The PC-QOL-27 survey was administered to ADC patients with chronic cough at initial clinic visit and 6 to 12 weeks after cough management. Pre and post survey scores, demographic data, treatment and evaluation season were collected over 16 months. RESULTS Twenty parents completed pre and post PC-QOL-27 surveys (mean 12.1 weeks later). Patient median age was 6.04 years (IQR: 2.2-10.44 years). A total of 65% were males and 65% were African American. Management was tailored based on clinical assessment and diagnostic studies, including direct laryngoscopy/bronchoscopy (4), pulmonary function tests (PFT's 9), esophagogastroduodenoscopy (9), and flexible bronchoscopy/lavage (9).Following ADC management, changes in physical, social and psychological domain scores of the PC-QOL-27 each met the threshold for minimal clinical important difference (MCID) indicating a clinically meaningful improvement. Improvements were most notable in the physical domain where post survey scores significantly improved from pre-survey scores (P = .009) regardless of age, gender, ethnicity, history of endoscopy and season. CONCLUSIONS The physical impact of chronic cough in pediatric patients who failed prior management by a single specialist was lessened by an ADC team approach to management.
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Affiliation(s)
- Betel A Yibrehu
- George Washington University School of Medicine, Washington, DC, USA
| | | | - Md Sohel Rana
- Children's National Health System, Washington, DC, USA
| | - Dinesh K Pillai
- George Washington University School of Medicine, Washington, DC, USA.,Children's National Health System, Washington, DC, USA
| | - Sona Sehgal
- George Washington University School of Medicine, Washington, DC, USA.,Children's National Health System, Washington, DC, USA
| | | | | | - Nancy M Bauman
- George Washington University School of Medicine, Washington, DC, USA.,Children's National Health System, Washington, DC, USA
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Carr MM, Ramadan J, Bauer E. Laryngomalacia in Neonates Versus Older Infants: HCUP-KID Perspective. Clin Pediatr (Phila) 2020; 59:679-685. [PMID: 32111124 DOI: 10.1177/0009922820908917] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study evaluated the hospital course for neonates and older infants with a diagnosis of laryngomalacia (LM). Data came from the 2016 Kids' Inpatient Database of the Healthcare Cost Utilization Project. A total of 6537 children aged <1 year with a diagnosis of LM (International Classification of Diseases, 10th Revision, code Q31.5) were identified: 2212 neonates and 4325 non-neonates. Neonates had a higher mortality rate, 1.31% versus 0.72% in older infants, had more diagnoses (median 9 vs 7) and procedures (mean 85.24 vs 21.83), longer length of stay (median 10 vs 4 days), and higher total charges (median US$65 722 vs US$25 582). A total of 23.3% of neonates born during the admission and diagnosed with LM had undergone laryngoscopy. Second airway lesions were present in 12.33% of neonates and 15.77% of older infants. It appears that neonates are being discharged with a diagnosis of LM without laryngoscopy. Neonatal intensive care unit and newborn nursery policies should require visualization of the larynx prior to diagnosis of LM.
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Affiliation(s)
| | - Jad Ramadan
- West Virginia University, Morgantown, WV, USA
| | - Emma Bauer
- West Virginia University, Morgantown, WV, USA
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35
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Sioshansi PC, Byrne E, Freccero A, Meister KD, Sidell DR. Risk Assessment and Early Mobilization Pathway Following Pediatric Tracheostomy: A Pilot Study. Laryngoscope 2020; 131:E653-E658. [PMID: 32438519 DOI: 10.1002/lary.28748] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/02/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To confirm the standard of care pertaining to postoperative mobilization practices following initial tracheostomy, to establish face validity of novel early mobilization tools, and to conduct a safety and feasibility pilot study. STUDY DESIGN Multi-institutional survey and prospective cohort study. METHODS Experts at our tertiary-care children's hospital developed an Early Pediatric Mobility Pathway for tracheostomy patients utilizing a novel risk-assessment tool. Surveys were distributed to professional colleagues in similar children's hospitals to establish face validity and incorporate respondent feedback. Additional surveys were disseminated to tertiary-care children's hospitals across the country to establish the current standard of care, and a pilot study was conducted. RESULTS Seventy-seven percent of respondents from tertiary hospitals across the country confirmed the standard of care to defer mobilization until the first trach change. Greater than 83% of the respondents used to establish face validity of the tools agreed with the clinical components and scoring structure. The safety and feasibility of early mobilization prior to initial trach change was confirmed with a pilot of 10 pediatric patients without any adverse events. CONCLUSIONS Mobilization of pediatric patients prior to initial trach change is feasible and can be safe when risk factors are assessed by a multidisciplinary team. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E653-E658, 2021.
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Affiliation(s)
- Pedrom C Sioshansi
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Eilish Byrne
- Lucile Packard Children's Hospital Stanford, Department of Rehabilitation Services, Stanford, California, U.S.A
| | - Allison Freccero
- Lucile Packard Children's Hospital Stanford, Department of Rehabilitation Services, Stanford, California, U.S.A
| | - Kara D Meister
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Pediatric Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Pediatric Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
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36
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Jayawardena ADL, Burks CA, Hartnick CJ. Bioabsorbable Microplates as an External Stent for Suprastomal Collapse: A Retrospective Review. Laryngoscope 2020; 131:E631-E634. [PMID: 32330306 DOI: 10.1002/lary.28699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/28/2019] [Revised: 03/16/2020] [Accepted: 04/07/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE/HYPOTHESIS To assess the long-term decannulation outcomes of bioresorbable microplates as an external stent for pediatric tracheostomy patients with suprastomal collapse. STUDY DESIGN Retrospective cohort study. METHODS Hospital records of all patients who underwent a bioresorbable microplate for suprastomal collapse from 2016 to 2019 were reviewed at a single institution. The primary outcome measure was tracheostomy decannulation. RESULTS A total of nine patients underwent placement of bioabsorbable microplates to treat suprastomal collapse. After initial tracheostomy, four patients received a laryngotracheal reconstruction prior to their external stent placement, and one patient received a mandibular distraction. The average age at the time of external stent placement was 32 (±21) months, excluding one patient who received a stent at the age of 29 years. Eight patients (88.9%) were successfully decannulated following the procedure. Decannulated patients were followed for an average of 21 (±12.5) months postoperatively, and all these patients have remained decannulated since their initial procedure. This is a total of 173 months (14.4 years) of observation postprocedure in which these patients have remained decannulated. One patient experienced postoperative crepitus requiring washout but still maintained decannulation. CONCLUSION Bioabsorbable microplates have a reasonable chance of long-term successful decannulation when an appropriate patient is selected. Decannulation is maintained beyond the 6-month time frame in which the 85:15 poly(L-lactide-co-glycolide) polymer that comprises the external stent takes to bioabsorb. This procedure should be considered for the often difficult problem of pediatric tracheostomy with isolated suprastomal collapse. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E631-E634, 2021.
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Affiliation(s)
- Asitha D L Jayawardena
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Ciersten A Burks
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Christopher J Hartnick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
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Drusin MA, Pereira NM, Modi VK. Intralingual Thyroglossal Duct Cyst Excision. Laryngoscope 2020; 131:205-208. [PMID: 32239767 DOI: 10.1002/lary.28610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Madeleine A Drusin
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
| | - Nicola M Pereira
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
| | - Vikash K Modi
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A.,Pediatric Otolaryngology-Head & Neck Surgery, New York Presbyterian Hospital, New York, New York, U.S.A
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38
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Luscan R, Leboulanger N, Fayoux P, Kerner G, Belhous K, Couloigner V, Garabedian EN, Simon F, Denoyelle F, Thierry B. Developmental changes of upper airway dimensions in children. Paediatr Anaesth 2020; 30:435-445. [PMID: 31995659 DOI: 10.1111/pan.13832] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 09/07/2019] [Revised: 01/09/2020] [Accepted: 01/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Knowledge about airway dimensions during child growth is of paramount importance for pediatric clinical practice. Decisions about airway management in children are based on relatively limited, imprecise, or incomplete data about airway size. AIMS The aim of this work was to determine the anatomical development and size of airway structures from birth to adolescence using high-resolution computed tomography scans and to study the correlation between airway measurements and biometric data. METHODS We conducted a retrospective study of all high-resolution computed tomography scans including the respiratory tract, performed in our tertiary pediatric center (for reasons unrelated to airway symptoms) between June 1, 2016, and October 15, 2017, on children aged from 1 day to 14 years old. On each scan, 23 measurements of the larynx, trachea, and mainstem bronchi were performed. Patients were stratified into 16 groups according to their age. We calculated median value for each measurement in each group. Statistical models were calculated to explore correlation between measurements and age or weight. RESULTS A total of 192 scans were included (127 boys/65 girls). The mean age was 7 years. The correlations between airway measurements and age or weight were always significant. The relationship between measurements and age was found to be suitably represented by a cubic polynomial equation suggesting that the airway has a rapid growth phase in the first 3 years, followed by a slow growth phase and a second rapid growth phase during adolescence. The most relevant biometric parameter was age concerning 21 of the measurements. CONCLUSION This comprehensive anatomical database of upper airway dimensions provides important data in the field of pediatric airway anatomy, particularly relating to the cricoid. We demonstrated that laryngeal, tracheal, and bronchial parameters correlate better to age and have three different growth phases.
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Affiliation(s)
- Romain Luscan
- Pediatric Otorhinolaryngology Department, APHP, Hôpital Universitaire Necker-Enfants-Malades, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
| | - Nicolas Leboulanger
- Pediatric Otorhinolaryngology Department, APHP, Hôpital Universitaire Necker-Enfants-Malades, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France.,INSERM U955 Team 13 - ERL 7240, Institut Mondor Pour la Recherche Biomédicale, Créteil, France
| | - Pierre Fayoux
- Pediatric Otorhinolaryngology - Head Neck Surgery - Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Gaspard Kerner
- Université de Paris, Université Paris Descartes, Paris, France.,Laboratory of Human Genetics of Infectious Diseases, INSERM UMR 1163, Necker Branch, Université de Paris, Paris, France
| | - Kahina Belhous
- Pediatric Radiology, APHP, Hôpital Universitaire Necker-Enfants-Malades, Paris, France
| | - Vincent Couloigner
- Pediatric Otorhinolaryngology Department, APHP, Hôpital Universitaire Necker-Enfants-Malades, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
| | - Erea-Noël Garabedian
- Pediatric Otorhinolaryngology Department, APHP, Hôpital Universitaire Necker-Enfants-Malades, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
| | - François Simon
- Pediatric Otorhinolaryngology Department, APHP, Hôpital Universitaire Necker-Enfants-Malades, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
| | - Françoise Denoyelle
- Pediatric Otorhinolaryngology Department, APHP, Hôpital Universitaire Necker-Enfants-Malades, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
| | - Briac Thierry
- Pediatric Otorhinolaryngology Department, APHP, Hôpital Universitaire Necker-Enfants-Malades, Paris, France.,Human Immunology, Pathophysiology and Immunotherapy, Division Stem cell Biotechnologies, INSERM, UMR976, Université de Paris, Paris, France
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39
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Bell JR, Cohen AP, Graff JT, Fleck RJ, O'Hara S, de Alarcon A, Hart CK. Pilot Study to Assess the Use of Ultrasound in Evaluating the Abnormal Pediatric Airway. Otolaryngol Head Neck Surg 2020; 162:950-953. [PMID: 32204669 DOI: 10.1177/0194599820912034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this study, we sought to explore the feasibility of using ultrasonography to evaluate airway anomalies in awake children with previous airway reconstruction. For the month of December 2018, we reviewed the medical records of patients aged <18 years old with prior airway reconstruction who had an outpatient appointment and a microlaryngoscopy and bronchoscopy within 24 hours of each other. Four patients met inclusion criteria and were enrolled. Sonographic airway images and measurements were obtained during the outpatient appointment and compared with those obtained during endoscopy. Ultrasound identified extraluminal stents and glottic, subglottic, and tracheal pathology. Subglottic measurements obtained sonographically were within 0.1 to 0.5 mm of the outer diameter of the appropriate endotracheal tubes. Ultrasound did not visualize tracheotomy tubes or posterolateral pathology. Our findings lay the foundation for expanding the role of ultrasound in pediatric airway assessment, keeping in mind its apparent inability to visualize posterolateral airway pathology.
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Affiliation(s)
- Jason R Bell
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Aliza P Cohen
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Justin T Graff
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Robert J Fleck
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sally O'Hara
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Huang AS, Sarver A, Widing A, Hajduk J, Jagannathan N. The design of the perfect pediatric supraglottic airway device. Paediatr Anaesth 2020; 30:280-287. [PMID: 31837186 DOI: 10.1111/pan.13785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/19/2019] [Revised: 11/29/2019] [Accepted: 12/06/2019] [Indexed: 11/28/2022]
Abstract
The design evolution of the pediatric supraglottic airway device has experienced a long and productive journey. We have a wealth of clinical studies to support progress and advancements in pediatric clinical practice. While all of the supraglottic airway devices have been used successfully in millions of children, it is important to be aware of design advantages and disadvantages of the different models of supraglottic airway devices. Current pediatric supraglottic airway devices may be improved in design to be more ideal. Industry-changing technological advancements are likely to occur in the near future, which may further improve clinical performance of these devices.
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Affiliation(s)
- Andrea S Huang
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ashley Sarver
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amanda Widing
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Narasimhan Jagannathan
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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41
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Wettstein RW, Gardner DD, Wiatrek S, Ramirez KE, Restrepo RD. Endotracheal cuff pressures in the PICU: Incidence of underinflation and overinflation. Can J Respir Ther 2020; 56:1-4. [PMID: 32095499 PMCID: PMC7011854 DOI: 10.29390/cjrt-2019-018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND While uncuffed endotracheal tubes have been traditionally used in the pediatric intensive care unit (PICU) population, evidence suggests cuffed endotracheal tubes (ETTs) are also safe to use within this population. Nevertheless, risks related to the use of cuffed ETTs increase when guidelines for safe and appropriate use are not followed. The primary goal of this study was to measure the cuff pressure (CP) using a cuff pressure manometer in a group of intubated pediatric subjects and determine the rate of cuff underinflation (<20 cm H20) or overinflation (>30 cm H20). The secondary aim was to determine whether CP was associated to gender, age, ETT size, and PICU length of stay prior to CP measurement. METHODS This was a prospective observational study conducted in an urban PICU. Pediatric subjects intubated with cuffed ETTs from 1 April 2017 to 1 May 2017 were included in the study. ETT CPs were measured daily to determine degree of inflation and compared according to gender, age, ETT size, and number of days intubated prior to CP measurement. Descriptive data are expressed as means and standard deviations. A two-sample t test was used to compare groups according to age, gender, and number of days present. And significance was considered with a P < 0.05. Pearson chi test was used to evaluate correlation between CPs and size of the ETT, number of days intubated prior to CP measurement, gender, and age. RESULTS Twenty pediatric subjects admitted during the study period were included for analysis. Eleven cuff measurements were found to be within normal limits, while 9 cuff measurements were found to be underinflated. No cases of overinflation were found. There were no significant associations between CP and size of the ETT (r = -0.08), number of days intubated prior to CP measurement (r = 0.19), gender (r = 0.09), and age (r = 0.12). CONCLUSIONS Our study suggests that endotracheal cuff underinflation occurs often in the PICU population. Strategies to ensure appropriate ETT CPs are maintained are essential in the intubated pediatric population. Additional studies are necessary to develop interventions and training focused on the use of a cuff pressure manometer to measure CPs in the PICU by respiratory therapists and ensure consistent measurement using inter rater evaluation processes are needed.
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Affiliation(s)
- Richard W. Wettstein
- Division of Respiratory Care, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Donna D. Gardner
- Department of Respiratory Care, Texas State University, Round Rock, TX
| | - Sadie Wiatrek
- Division of Respiratory Care, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Kristina E. Ramirez
- Division of Respiratory Care, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ruben D. Restrepo
- Division of Respiratory Care, The University of Texas Health Science Center at San Antonio, San Antonio, TX
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42
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Orhan-Sungur M, Altun D, Özkan-Seyhan T, Aygün E, Koltka K, Çamcı E. Learning curve of ultrasound measurement of subglottic diameter for endotracheal tube selection in pediatric patients. Paediatr Anaesth 2019; 29:1194-1200. [PMID: 31583796 DOI: 10.1111/pan.13751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/08/2019] [Revised: 09/09/2019] [Accepted: 10/01/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Endotracheal tube size can be predicted according to ultrasound measurement of subglottic airway diameter. The learning curve for this method is not yet established. The aim was to evaluate the learning curve of anesthesiology residents in ultrasound measurement of subglottic airway diameter for prediction of endotracheal tube size using cumulative sum analysis. METHODS Sixteen anesthesiology residents measured transverse subglottic airway diameter in children undergoing general anesthesia with cuffed endotracheal intubation. Each resident performed 30 ultrasound examinations. Primary outcome was the successful prediction of endotracheal tube size according to ultrasound measurement. Cumulative sum analysis was performed with acceptable and unacceptable failure rates set as 20 and 40%, respectively. RESULTS Ten out of 16 residents (62.5%) were deemed successful as they were able to pass lower decision boundary, whereas six residents' CUSUM scores were between the decisions lines deeming them indeterminate. The overall success rate for determining the correct endotracheal tube size was 77.5%. Median number of attempts to cross lower decision boundary was 29 with minimum of 18 and maximum of 29 attempts among successful residents. CONCLUSION Learning curves constructed with cumulative sum analysis in this study showed that only 62.5% of residents were able to correctly predict cuffed endotracheal tube size with 80% success rate. Considerable variability in achieving competency necessitates objective follow-up of individual improvement.
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Affiliation(s)
- Mukadder Orhan-Sungur
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Demet Altun
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tülay Özkan-Seyhan
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elif Aygün
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kemalettin Koltka
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emre Çamcı
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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43
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Patel AP, Meghji S, Phillips JS. Accuracy of clinical scoring tools for the diagnosis of pediatric obstructive sleep apnea. Laryngoscope 2019; 130:1034-1043. [PMID: 31233218 DOI: 10.1002/lary.28146] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 05/09/2019] [Accepted: 06/03/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the diagnostic test accuracy of questionnaire and clinical examination-based scoring tools in the diagnosis of pediatric obstructive sleep apnea (OSA). METHODS A comprehensive literature search was performed to identify studies published from 1960 to 2018 that evaluated the accuracy of clinical scoring tools in the diagnosis of pediatric OSA. Studies that did not include attended polysomnography as a reference standard were excluded. The study populations were children under 18 years old without craniofacial abnormalities, congenital syndromes, or other complex medical conditions. Outcomes measures were diagnostic test accuracy (DTA) statistics including sensitivity, specificity, and area under the curve (AUC) from receiver operating characteristic curve analysis. RESULTS Fifteen different scoring tools were identified. Authors chose different polysomnographic criteria to diagnose OSA. Four of the tools had undergone multiple DTA studies by different authors (OSA Score, Sleep-Related Breathing Disorder [SRBD] scale, Severity Score, and OSA-18). The Pediatric Sleep Questionnaire SRBD scale, which is widely used, has a sensitivity of 71% to 84% in included studies, but specificity as low as 13% and a low AUC of 0.57-0.69, indicating poor diagnostic accuracy. None of the 15 scoring tools performed well enough to be considered accurate diagnostic tests for pediatric OSA. CONCLUSIONS A well-designed questionnaire can provide crucial information on the impact of sleep-disordered breathing on a child's physical and psychological health, which may not be adequately reflected in objective polysomnography outcomes measures. However, DTA results indicate that published clinical scoring tools do not accurately predict a diagnosis of pediatric OSA as defined by polysomnography outcome measures. Laryngoscope, 130:1034-1043, 2020.
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Affiliation(s)
- Anant P Patel
- Department of Ear, Nose, and Throat Surgery, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Sheneen Meghji
- Department of Ear, Nose, and Throat Surgery, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, United Kingdom
| | - John S Phillips
- Department of Ear, Nose, and Throat Surgery, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, United Kingdom
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44
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Thottam PJ, Gilliland T, Ettinger N, Baijal R, Mehta D. Outcomes Using a Postoperative Protocol in Pediatric Single-Stage Laryngotracheal Reconstruction. Ann Otol Rhinol Laryngol 2019; 130:861-867. [PMID: 30767561 DOI: 10.1177/0003489419830107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate single-stage laryngotracheal reconstruction (ssLTR) outcomes before and after the implementation of a postoperative care protocol in pediatric patients. METHODS A case-control study with chart review was conducted at 2 tertiary academic centers from 2010 to 2016. Pediatric patients who underwent ssLTR with a postoperative care protocol were compared with those who did not receive care under this protocol. Data regarding perioperative management were collected and compared using χ2 and Wilcoxon rank tests. Planned extubation, length of intubation in the intensive care unit, and complications were examined. RESULTS Nineteen patients completed ssLTR after the protocol was initiated, and 26 prior patients were used as control subjects. Planned extubation failed in 9 patients (35%) in the control group compared with 1 patient (5%) in the protocol group (P < .05). Using a structured protocol demonstrated a decrease in delayed extubation and intensive care unit stay (P < .05). Despite more postprotocol patients' requiring posterior graft placement, preprotocol patients were less likely to be extubated within 7 days (P < .05). CONCLUSIONS The authors propose an intensive care unit protocol that uses a combination of pharmacologic agents to optimally reduce the risk for adverse events that delay time to extubation and thus decannulation. Timely extubation was more likely with the use of this postoperative care protocol using a multidisciplinary approach involving otolaryngologists, pharmacists, intensivists, and anesthesiologists.
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Filauro M, Mazzola F, Missale F, Canevari FR, Peretti G. Endoscopic Preoperative Assessment, Classification of Stenosis, Decision-Making. Front Pediatr 2019; 7:532. [PMID: 31970144 PMCID: PMC6960172 DOI: 10.3389/fped.2019.00532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
Pediatric Laryngo-Tracheal Stenosis (LTS) comprises different conditions that require precise preoperative assessment and classification. According to the guidelines, the optimal diagnostic work-up of LTS patients relies both on a comprehensive anamnesis and on endoscopic and radiological assessments. All the causes of LTS result in an impairment in airflow, mucociliary clearance, phonation, and sometimes in swallowing disorders. The main goals of treatment are to maintain an adequate respiratory space and restore the Upper Aero-Digestive Tract (UADT) physiology. The first step when dealing with LTS patients is to properly assess their medical history. The main causes of pediatric LTS can be divided into two groups, i.e., congenital and acquired. The most common causes of congenital LTS are: laryngomalacia (60%), vocal fold paralysis (15-20%), subglottic stenosis (SGS) (10-15%), laryngeal webs and atresia (5%), subglottic hemangioma (1.5-3%), and others. On the other hand, 90% of acquired pediatric LTS cases are subsequent to post-intubation injuries. Other less frequent causes are: iatrogenic complications from endoscopic laryngeal interventions, benign tumors, caustic or thermal injuries, external blunt force injury or trauma, chronic inflammatory disorders, or idiopathic causes. Diagnostic work-up consists in a step-by-step investigation: awake and asleep transnasal fiberoptic laryngoscopy (TNFL), direct laryngoscopy with 0° and angled telescopes to investigate the type of stenosis (arytenoid mobility, craniocaudal extension, involved anatomical sites, and active or mature scar tissue), and broncho-esophagoscopy to rule out associated mediastinal malformations. To date there are several available classifications for each of the involved sites: Cohen's classification for anterior glottic stenosis, Bogdasarian's for posterior glottic stenosis (PGS) and Myer-Cotton's for subglottic stenosis, even though others are used in daily practice (Lano-Netterville, FLECS, etc.). The European Laryngological Society recently proposed a new classification which is applicable in all LTS cases. In this chapter we deal with preoperative assessment and staging, reviewing the most relevant classifications applicable in patients affected by LTS, conditio sine qua non in order to tailor the best treatment modality to each subject. We'll also detail the comprehensive radiological, endoscopic and functional assessment for the correct use of each staging classification.
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Affiliation(s)
- Marta Filauro
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Francesco Mazzola
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Frank Rikki Canevari
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy
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McDaniel LS, Poynot WJ, Gonthier KA, Dunham ME, Crosby ATW. Image-Based 3-Dimensional Characterization of Laryngotracheal Stenosis in Children. OTO Open 2018; 2:2473974X17753583. [PMID: 30480204 PMCID: PMC6239028 DOI: 10.1177/2473974x17753583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/01/2017] [Accepted: 12/22/2017] [Indexed: 12/03/2022] Open
Abstract
Objectives Describe a technique for the description and classification of
laryngotracheal stenosis in children using 3-dimensional reconstructions of
the airway from computed tomography (CT) scans. Study Design Cross-sectional. Setting Academic tertiary care children’s hospital. Subjects and Methods Three-dimensional models of the subglottic airway lumen were created using CT
scans from 54 children undergoing imaging for indications other than airway
disease. The base lumen models were deformed in software to simulate
subglottic airway segments with 0%, 25%, 50%, and 75% stenoses for each
subject. Statistical analysis of the airway geometry was performed using
metrics extracted from the lumen centerlines. The centerline analysis was
used to develop a system for subglottic stenosis assessment and
classification from patient-specific airway imaging. Results The scaled hydraulic diameter gradient metric derived from intersectional
changes in the lumen can be used to accurately classify and quantitate
subglottic stenosis in the airway based on CT scan imaging. Classification
is most accurate in the clinically relevant 25% to 75% range of
stenosis. Conclusions Laryngotracheal stenosis is a complex diagnosis requiring an understanding of
the airway lumen configuration, anatomical distortions of the airway
framework, and alterations of respiratory aerodynamics. Using image-based
airway models, we have developed a metric that accurately captures
subglottis patency. While not intended to replace endoscopic evaluation and
existing staging systems for laryngotracheal stenosis, further development
of these techniques will facilitate future studies of upper airway
computational fluid dynamics and the clinical evaluation of airway
disease.
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Affiliation(s)
- Lee S McDaniel
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - William J Poynot
- Department of Mechanical & Industrial Engineering, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Keith A Gonthier
- Department of Mechanical & Industrial Engineering, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Michael E Dunham
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - And Tyler W Crosby
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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Kimbell JS, Basu S, Garcia GJM, Frank-Ito DO, Lazarow F, Su E, Protsenko D, Chen Z, Rhee JS, Wong BJ. Upper airway reconstruction using long-range optical coherence tomography: Effects of airway curvature on airflow resistance. Lasers Surg Med 2018; 51:150-160. [PMID: 30051633 DOI: 10.1002/lsm.23005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Adenotonsillectomy (AT) is commonly used to treat upper airway obstruction in children, but selection of patients who will benefit most from AT is challenging. The need for diagnostic evaluation tools without sedation, radiation, or high costs has motivated the development of long-range optical coherence tomography (LR-OCT), providing real-time cross-sectional airway imaging during endoscopy. Since the endoscope channel location is not tracked in conventional LR-OCT, airway curvature must be estimated and may affect predicted airway resistance. The study objective was to assess effects of three realistic airway curvatures on predicted airway resistance using computational fluid dynamics (CFD) in LR-OCT reconstructions of the upper airways of pediatric patients, before and after AT. METHODS Eight subjects (five males, three females, aged 4-9 years) were imaged using LR-OCT before and after AT during sedated endoscopy. Three-dimensional (3D) airway reconstructions included three airway curvatures. Steady-state, inspiratory airflow simulations were conducted under laminar conditions, along with turbulent simulations for one subject using the k-ω turbulence model. Airway resistance (pressure drop/flow) was compared using two-tailed Wilcoxon signed rank tests. RESULTS Regardless of the airway curvatures, CFD findings corroborate a surgical end-goal with computed post-operative airway resistance significantly less than pre-operative (P < 0.01). The individual resistances did not vary significantly for different airway curvatures (P > 0.25). Resistances computed using turbulent simulations differed from laminar results by less than ∼5%. CONCLUSIONS The results suggest that reconstruction of the upper airways from LR-OCT imaging data may not need to account for airway curvature to be predictive of surgical effects on airway resistance. Lasers Surg. Med. 51:150-160, 2019. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Julia S Kimbell
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Saikat Basu
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Guilherme J M Garcia
- Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin.,Medical College of Wisconsin, Biotechnology and Bioengineering Center, Milwaukee, Wisconsin
| | - Dennis O Frank-Ito
- Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina
| | - Frances Lazarow
- Beckman Laser Institute, University of California, Irvine, California
| | - Erica Su
- Beckman Laser Institute, University of California, Irvine, California
| | - Dimitry Protsenko
- Beckman Laser Institute, University of California, Irvine, California
| | - Zhongping Chen
- Beckman Laser Institute, University of California, Irvine, California
| | - John S Rhee
- Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian J Wong
- Beckman Laser Institute, University of California, Irvine, California.,Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
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Kavookjian H, Jones JW, Shah S, Escobar H, Swanson D, Nicklaus P. Endobronchial Non-Tuberculosis Mycobacterium Infection Presenting in a Healthy Child. Ann Otol Rhinol Laryngol 2018; 127:726-730. [PMID: 29962232 DOI: 10.1177/0003489418784970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe a safe and effective treatment for endobronchial Mycobacterium avium complex. METHODS Case report and literature review. RESULTS We present a case of endobronchial M. avium complex in a healthy child treated with serial carbon-dioxide laser excisions and antibiotic triple therapy using azithromycin, rifampin, and ethambutol. No current guideline for the treatment of these lesions in the pediatric population exists. CONCLUSIONS In patients with airway impingement, serial endoscopic surgical resection combined with antibiotics can provide safe and effective management.
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Affiliation(s)
- Hannah Kavookjian
- 1 Department of Otolaryngology Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joel W Jones
- 1 Department of Otolaryngology Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sweeti Shah
- 2 Department of Otolaryngology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Hugo Escobar
- 3 Department of Pulmonology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Douglas Swanson
- 4 Department of Infectious Disease, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Pamela Nicklaus
- 2 Department of Otolaryngology, Children's Mercy Hospital, Kansas City, Missouri, USA
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Mildenhall NR, Raynor EM. Double Carina: A Novel Tracheo-Bronchial Anomaly Found During a Pediatric Airway Evaluation. Ann Otol Rhinol Laryngol 2018; 127:406-408. [PMID: 29717653 DOI: 10.1177/0003489418770204] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To present a novel pediatric airway anomaly encountered on direct laryngoscopy and bronchoscopy, further characterized with computed tomography imaging of the chest. STUDY DESIGN Case report and literature review. METHODS Review of the clinical presentation, operative findings, and imaging findings of an infant who presented with respiratory distress in the setting of multiple congenital abnormalities. A brief literature review supplements the case presentation. RESULTS While multiple tracheobronchial anomalies have long been reported, this is the first report of a double or false carina: a system of symmetric paired upper and lower bronchi connected by a central conduit. Operative evaluation was limited given the narrow lumen, and postoperative imaging aided in further characterization of the pediatric airway. CONCLUSIONS This is the first report of a novel tracheobronchial anomaly presenting as a double carina. Tracheobronchial anomalies are diverse and should be considered when performing operative airway evaluations. Imaging can be a helpful adjunct with anatomic characterization.
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Affiliation(s)
- Nicholas R Mildenhall
- 1 Duke Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Eileen M Raynor
- 1 Duke Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Abstract
OBJECTIVES To share the diagnostic and management challenges created by an extremely rare airway lesion-the subglottic ectopic thymic cyst. STUDY DESIGN Case report and literature review. METHODS We review the presentation, management, and clinical course of an infant who presented with a subglottic mass that was histologically confirmed as a thymic cyst. A brief literature review supplements the case presentation Results: We present the third described case of an ectopic thymic cyst presenting as a subglottic mass. The differential diagnosis of subglottic masses in neonates consists primarily of subglottic hemangioma and mucous retention cysts. Otolaryngologists must be prepared for unexpected findings when dealing with critical airways. We compare the presentation and management of our patient with the 2 previously described cases. We propose an embryologic theory for the origin of these rare lesions. CONCLUSIONS An ectopic thymic cyst is a rare and unexpected cause of neonatal stridor. Management of pediatric airway lesions must allow for unexpected findings at the time of diagnostic and therapeutic endoscopy. The appropriate management of subglottic thymic cysts is poorly defined, but close surveillance for recurrence is mandatory.
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Affiliation(s)
- Iram Ahmad
- 1 Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Patricia Kirby
- 2 Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Bryan Liming
- 3 Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii, USA
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