An Evaluation Protocol of the Upper Airway for Pediatric Patients with Stridor or Extubation Failure.
10.3342/kjorl-hns.2016.59.1.35
- Author:
Jun Oh PARK
1
;
Woori PARK
;
Jungkyu CHO
;
Joongbum CHO
;
Jin Kyoung KIM
;
Han Sin JEONG
Author Information
1. Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. hansin.jeong@gmail.com
- Publication Type:Original Article
- Keywords:
Evaluation;
Extubation failure;
Pediatrics;
Stridor;
Upper airway
- MeSH:
Anesthesiology;
Cardiovascular Diseases;
Comorbidity;
Constriction, Pathologic;
Cooperative Behavior;
Diagnosis;
Dilatation;
Humans;
Critical Care;
Laryngomalacia;
Lung Diseases;
Pediatrics;
Prognosis;
Respiratory Sounds*;
Retrospective Studies;
Tracheal Stenosis;
Tracheostomy
- From:Korean Journal of Otolaryngology - Head and Neck Surgery
2016;59(1):35-40
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND AND OBJECTIVES: Adequate evaluation of the upper airway is critical in the management of pediatric patients with stridor or extubation failure. For this purpose, we designed an evaluation protocol of the upper airway for these patients, in collaboration with Dept. of Pediatrics, Intensive care team and Anesthesiology. Here we present the clinical results of our evaluation protocol and provide information about the etiology and management of the upper airway problems. SUBJECTS AND METHOD: Clinical data of 380 pediatric patients (M:F=231:149) having airway evaluation for their problems (stridor or extubation failure) were retrospectively analyzed. Among them, patients of age less than 3 months ranked first (30.0%). Comorbidities of pulmonary diseases (30.8%) and cardiovascular diseases (29.5%) were found. The pre and post-evaluation diagnosis, management and prognosis were evaluated and the usefulness of an airway evaluation protocol was discussed. RESULTS: Frequent pre-evaluation diagnoses were subglottic stenosis (55.2%), laryngomalacia (12.6%) and tracheal stenosis (9.2%) and these were changed to subglottic stenosis (44.5%), laryngomalacia (9.7%), tracheal stenosis (6.6%) and no abnormality (14.5%). Particularly, 50% of pre-diagnosis laryngomalacia, 25% of subglottic stenosis and 37% of tracheal stenosis were corrected to other causes by airway evaluation. The procedures were exam only (41.6%), endoscopic dilatation (20.8%) and tracheostomy (17.9%). In 190 out of 380 (50.0%), extubation was successful, but 151 patients (39.7%) had tracheostomy tube. CONCLUSION: Adequate evaluation of the upper airway in pediatric patients with stridor or extubation failure can facilitate the diagnosis and management of their problems.
