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Subglottic Stenosis Following Cardiac Surgery With Cardiopulmonary Bypass in Infants and Children. Pediatr Crit Care Med 2017; 18:429-433. [PMID: 28277376 DOI: 10.1097/pcc.0000000000001125] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the 1) incidence of subglottic stenosis in infants and children following cardiac surgery with cardiopulmonary bypass and 2) risk factors associated with its development. DESIGN Retrospective cohort study. SETTING Tertiary children's hospital in California. PATIENTS Infants and children who underwent cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Diagnosis of subglottic stenosis by tracheoscopy. MEASUREMENTS AND MAIN RESULTS The incidence of subglottic stenosis at our institution during the study period was 0.7%. Young age (p = 0.014), prolonged cardiopulmonary bypass (p = 0.03), and prolonged mechanical ventilation (p < 0.01) were associated with the development of subglottic stenosis. Gender, chromosomal anomaly, presence of a cuffed endotracheal tube, and lowest core temperature during cardiopulmonary bypass were not associated with the development of subglottic stenosis. CONCLUSIONS The incidence of subglottic stenosis was less than that previously reported in this population. Although the incidence is relatively low, subglottic stenosis is a serious complication of tracheal intubation and all measures to prevent subglottic stenosis should be undertaken.
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Mortelliti CL, Mortelliti AJ. Incremental change in cross sectional area in small endotracheal tubes: A call for more size options. Int J Pediatr Otorhinolaryngol 2016; 87:110-3. [PMID: 27368454 DOI: 10.1016/j.ijporl.2016.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To elucidate the relatively large incremental percent change (IPC) in cross sectional area (CSA) in currently available small endotracheal tubes (ETTs), and to make recommendation for lesser incremental change in CSA in these smaller ETTs, in order to minimize iatrogenic airway injury. METHODS The CSAs of a commercially available line of ETTs were calculated, and the IPC of the CSA between consecutive size ETTs was calculated and graphed. The average IPC in CSA with large ETTs was applied to calculate identical IPC in the CSA for a theoretical, smaller ETT series, and the dimensions of a new theoretical series of proposed small ETTs were defined. RESULTS The IPC of CSA in the larger (5.0-8.0 mm inner diameter (ID)) ETTs was 17.07%, and the IPC of CSA in the smaller ETTs (2.0-4.0 mm ID) is remarkably larger (38.08%). Applying the relatively smaller IPC of CSA from larger ETTs to a theoretical sequence of small ETTs, starting with the 2.5 mm ID ETT, suggests that intermediate sizes of small ETTs (ID 2.745 mm, 3.254 mm, and 3.859 mm) should exist. CONCLUSION We recommend manufacturers produce additional small ETT size options at the intuitive intermediate sizes of 2.75 mm, 3.25 mm, and 3.75 mm ID in order to improve airway management for infants and small children.
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Affiliation(s)
| | - Anthony J Mortelliti
- Division of Pediatric Otolaryngology, Department of Otolaryngology & Communication Sciences, SUNY Upstate Medical University, Syracuse, NY, USA.
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Wilson MN, Bergeron LM, Kakade A, Simon LM, Caspi J, Pettitt T, Kluka EA. Airway Management following Pediatric Cardiothoracic Surgery. Otolaryngol Head Neck Surg 2013; 149:621-7. [DOI: 10.1177/0194599813498069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives (1) Review airway management in pediatric patients undergoing cardiothoracic surgery (CTS); (2) determine the incidence of airway-related complications of CTS in this population. Design Case series with chart review. Setting Tertiary care children’s hospital. Patients Children undergoing CTS over a 4-year period. Methods Patients who underwent CTS at a single, tertiary care, children’s hospital between June 1, 2007, and May 31, 2011, were retrospectively reviewed; those <18 years who had open CTS were included. Statistical analysis examined relationships of intubation duration, complications, and need for tracheotomy while comparing patient characteristics, comorbidities, and types of surgery. Results Eight hundred seventy-five primary surgeries in 745 patients met inclusion criteria. Mean postoperative intubation duration was 7.2 days and median 3 days. On univariate analysis, significantly longer postoperative intubation requirements were found in patients younger in age, with congenital comorbidities or prematurity, with preoperative ventilation requirements, and those with early postoperative complications. Multivariate analysis found younger age, presence of congenital comorbidities, preoperative intubation requirements, and early postoperative complications each lengthen ventilation requirements. Four patients developed vocal cord paralysis and 5 developed phrenic nerve palsy. Nineteen patients required tracheotomy. Conclusions In this large cohort, CTS in the pediatric population is associated with few long-term or permanent airway-related complications. Patients who are younger in age and those with congenital comorbidities, preoperative ventilation requirements, or early postoperative complications required longer periods of postoperative intubation.
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Affiliation(s)
- Meghan N. Wilson
- Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - Lauren M. Bergeron
- Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | | | - Lawrence M. Simon
- Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
- Children’s Hospital of New Orleans, New Orleans, Louisiana, USA
| | - Joseph Caspi
- Children’s Hospital of New Orleans, New Orleans, Louisiana, USA
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - Timothy Pettitt
- Children’s Hospital of New Orleans, New Orleans, Louisiana, USA
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - Evelyn A. Kluka
- Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
- Children’s Hospital of New Orleans, New Orleans, Louisiana, USA
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