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Can Fraction of Inspired Oxygen Predict Extubation Failure in Preterm Infants? CHILDREN 2022; 9:children9010030. [PMID: 35053655 PMCID: PMC8774464 DOI: 10.3390/children9010030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
Abstract
Background: Prolonged mechanical ventilation in preterm infants may cause complications. We aimed to analyze the variables affecting extubation outcomes in preterm infants at high risk of extubation failure. Methods: This was a single-center, observational, retrospective study. Extubation failure was defined as survival with the need for reintubation within 72 h. Successfully extubated neonates (group 1) were compared to those with failed extubation (group 2). Multivariate logistic regression analysis evaluated factors that predicted extubation outcomes. Results: Eighty infants with a birth weight under 1000 g and/or gestational age (GA) under 28 weeks were included. Extubation failure occurred in 29 (36.2%) and success in 51 (63.8%) neonates. Most failures (75.9%) occurred within 24 h. Pre-extubation inspired oxygen fraction (FiO2) of 27% had a sensitivity of 58.6% and specificity of 64.7% for extubation failure. Post-extubation FiO2 of 32% had a sensitivity of 65.5% and specificity of 62.8% for failure. Prolonged membrane rupture (PROM) and high GA were associated with extubation success in multivariate logistic regression analysis. Conclusions: High GA and PROM were associated with extubation success. Pre- and post-extubation FiO2 values were not significantly predictive of extubation failure. Further studies should evaluate if overall assessment, including ventilatory parameters and clinical factors, can predict extubation success in neonates.
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Kuranova LB, Soldatskiy YL, Pavlov PV, Zakharova ML, Kovalets ES. [Laryngeal cysts in children]. Vestn Otorinolaringol 2021; 86:57-61. [PMID: 34964331 DOI: 10.17116/otorino20218606157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Laryngeal cysts in children are relatively rare, occupying the 4-5th place in the structure of congenital malformations. The paper presents the combined experience of two Russian pediatric otorhinolaryngological clinics traditionally involved in the rehabilitation of patients with congenital and acquired pathology of the larynx. OBJECTIVE To analyze the features of the clinic, diagnosis and treatment of laryngeal cysts in children. MATERIAL AND METHODS The study included 68 children with laryngeal cysts aged from 3 days to 16 years (on average 39.5±37.0 months, Me=15.5 months). The cyst was localized in the vestibular region of the larynx in 15 (22.1%) patients, in the vocal region - in 15 (22.1%) patients, and in the sub-vocal region - in 38 (55.9%) patients. Data on the presence of a history of tracheal intubation were available in 35 (89.7%) children, including 35 (92.1%) of 38 children with a subfold cyst. 11 patients were admitted with a previously applied tracheostomy. RESULTS The main reasons for going to the clinic were signs of laryngeal stenosis (stridor, signs of obstruction of the upper airways) in 60.3% of patients, dysphonia - in 33.8%, and in 5.9%, the detection of a cyst became an accidental finding. To eliminate the cyst, the method of laser marsupialization was used in 10 patients, coagulatory ablation - in 2 patients, in the remaining 56 patients, decortication was performed with microinstruments, followed by laser treatment of the cyst bed. In the follow-up, children were traced from 6 months to 7 years. We did not observe a recurrence of a cyst in any case. CONCLUSION Currently, the lining department is the "favorite" localization of the cyst in childhood. Subclavian cysts are more common in preterm infants who need tracheal intubation. A necessary condition for radical elimination is the resection of the cyst walls.
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Affiliation(s)
- L B Kuranova
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - Yu L Soldatskiy
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - P V Pavlov
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - M L Zakharova
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - E S Kovalets
- Morozovskaya Children's City Clinical Hospital, Moscow, Russia
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Chandran A, Sagar P, Kumar R, Shreshtha N. Addressing a rare cause of paediatric stridor: subglottic cyst. BMJ Case Rep 2020; 13:13/6/e236600. [PMID: 32595124 PMCID: PMC7322319 DOI: 10.1136/bcr-2020-236600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Aswin Chandran
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Prem Sagar
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Nisheshraj Shreshtha
- Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
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See GB, Mesran I. Stridor Secondary to Acquired Subglottic Cyst: Rarity Makes it Missed. Indian J Otolaryngol Head Neck Surg 2016; 71:45-48. [PMID: 31741928 DOI: 10.1007/s12070-016-0992-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 05/03/2016] [Indexed: 10/21/2022] Open
Abstract
Subglottic cysts (SGCs) are a rare cause of airway obstruction in children. Medical advances, higher survival rates for preterm infants, and improved diagnostic equipment have increased the number of reported cases of SGCs over the last three decades, the majority occurring in infants who had been extremely premature neonates and had suffered from respiratory distress, therefore having been intubated and managed in neonatal ICUs. Symptoms of laryngeal cysts depend on the size and the location of the cyst and include a change in the tone of voice, dysphonia, hoarseness, dysphagia, stridor, and dyspnea. This condition is often misdiagnosed as laryngomalacia, asthma, croup, or other diseases, due to the fact that it manifests as recurring respiratory infections, stridor, and wheezing. Death can occur in severe cases that are not treated. When present, it may account for severe inspiratory stridor that compromise the airway. The accepted gold standard treatment is direct laryngoscopy with marsupialization of the cyst to prevent recurrence. Two cases of subglottic cyst in our centre are described here. Although all cases presented differently, but in both of our cases, which have previous history of intubation with prematurity were initially diagnosed as laryngomalacia and croup.
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Affiliation(s)
- Goh Bee See
- Department of Otorhinolaryngology-Head Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Izham Mesran
- Department of Otorhinolaryngology-Head Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
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Surgical Management of Acquired Subglottic Cysts. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013. [DOI: 10.1016/j.otoeng.2013.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Surgical management of acquired subglottic cysts. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 64:371-3. [PMID: 22502737 DOI: 10.1016/j.otorri.2012.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 02/15/2012] [Accepted: 02/19/2012] [Indexed: 11/21/2022]
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Nouri-Merchaoui S, Yacoubi MT, Hmissa S, Kalamoun I, Mahdhaoui N, Seboui H. [Congenital laryngeal cyst: an uncommon cause of stridor in neonates]. Arch Pediatr 2012; 19:425-8. [PMID: 22381664 DOI: 10.1016/j.arcped.2012.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 09/06/2011] [Accepted: 01/20/2012] [Indexed: 11/29/2022]
Abstract
Laryngeal cyst is a rare but generally benign lesion in the larynx. It may cause stridor and life-threatening airway obstruction in early infancy. We report the case of a neonate who developed respiratory distress 24h after birth in relation with materno-fetal infection. Airway obstruction was then suspected because of stridor. A laryngeal mass was discovered at the time of intubation. The infant experienced a nosocomial infection and died on day 14 of life before any surgical treatment. Autopsy concluded in an epiglottic congenital laryngeal cyst.
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Management and prevention of endotracheal intubation injury in neonates. Curr Opin Otolaryngol Head Neck Surg 2011; 19:474-7. [DOI: 10.1097/moo.0b013e32834c7b5c] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Jaryszak EM, Collins WO. Microdebrider resection of bilateral subglottic cysts in a pre-term infant: a novel approach. Int J Pediatr Otorhinolaryngol 2009; 73:139-42. [PMID: 18986712 DOI: 10.1016/j.ijporl.2008.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2008] [Revised: 09/15/2008] [Accepted: 09/16/2008] [Indexed: 11/29/2022]
Abstract
Acquired subglottic cysts are a rare cause of stridor in infants. The two major risk factors for development of these cysts are prematurity and history of intubation. Microlaryngeal decompression and carbon dioxide laser resection of these cysts have been the most common treatment methods with recurrence rates as high as 43% [J. Lim, W. Hellier, J. Harcourt, S. Leighton, D. Albert, Subglottic cysts: the Great Ormond Street experience, Int. J. Pediatr. Otorhinolaryngol. 67 (2003) 461-465]. Carbon dioxide laser therapy also carries the risk of airway fire, injury to adjacent structures, and possible delayed scarring. We present a case of bilateral subglottic cysts in a premature infant with progressive stridor, treated using a microdebrider, and review the literature regarding the treatment of these lesions.
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Affiliation(s)
- Eric M Jaryszak
- Department of Otolaryngology-Head and Neck Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
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Abstract
An endotracheal tube placed in the larynx, even for a short time, causes at least superficial mucosal damage, an injury that normally heals readily. Long-term intubation, on the other hand, may cause pressure necrosis that can extend into submucosa, perichondrium, and eventually cartilage. The sites of involvement include the medial surface of the arytenoid cartilages, vocal processes, cricoarytenoid joints, posterior glottis, and subglottis. We review the pathogenesis, endoscopic recognition, classification, and progression of intubation injuries and examine the many variables that influence them. Diagrammatic flow charts trace the acute injuries through to their chronic sequelae, including subglottic stenosis, which is commoner in infants and children, and posterior glottic stenosis, which is commoner in adults. Systematic endoscopic assessment, under general anesthesia, using rigid telescopes to evaluate laryngeal damage during intubation is recommended and critically discussed. Endoscopy permits an informed judgment with regard to continuation of intubation. Depending on the severity and depth of ulceration, intubation can be continued (sometimes with a tube of smaller diameter) or tracheotomy performed, with an awareness of the attendant risks and benefits. Unnecessary tracheotomies may be avoided. Further, it may be possible to minimize untoward outcomes of prolonged intubation by using management techniques directed at known risk factors.
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Watson GJ, Malik TH, Khan NA, Sheehan PZ, Rothera MP. Acquired paediatric subglottic cysts: a series from Manchester. Int J Pediatr Otorhinolaryngol 2007; 71:533-8. [PMID: 17239962 DOI: 10.1016/j.ijporl.2006.11.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 11/07/2006] [Accepted: 11/07/2006] [Indexed: 11/20/2022]
Abstract
UNLABELLED Subglottic cysts (SGC) have long been regarded as a rare cause of airway obstruction but through increased awareness an increase in the number of cases of SGC has been reported. OBJECTIVE This paper describes the pathogenesis and management of SGC. DESIGN Retrospective case series. Ethical approval not sought. SETTING Royal Manchester Children's Hospital. PATIENTS Two hundred and six new referrals for direct laryngotracheobronchoscopy (DLTB) were identified from records between September 2003 and September 2005. MAIN OUTCOMES MEASURED Age at birth, sex, length of intubation, presenting symptoms, age at presentation, DLTB findings, interventional procedures, and follow-up DLTBs. RESULTS Fourteen out of 206 (6.8%) infants were diagnosed as with subglottic cysts. This represented the fourth most common cause of upper airway pathology. Thirteen out of 14 (93%) infants were preterm (26.8 weeks S.D. 25.3-28.3 weeks). All infants had been intubated ranging from 1 to 180 days (median 42 days). The onset of symptoms ranged from 1 to 13 months (median 4.25 months). Initially, 8/14 (57.2%) infants had SGC cysts marsupialised with microforceps. A further six cysts (50%) were decapped between 2 and 4 months and one between 6 and 12 months. CONCLUSION The number of cases of SGC has been increasing over the last three decades and represents the fourth most common causes of airway obstruction in our series. There is a delay in onset of symptoms and high rate of recurrence in the first 4 months. It is therefore prudent to reschedule further endoscopic evaluation between 2 and 4 months and after 6 months should the clinical need arise.
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Affiliation(s)
- Glen J Watson
- University Department of Otolaryngology Head and Neck Surgery, Hope Hospital, United Kingdom.
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Bokhari A, Heller DS, Fonseca C, Mirani N. Subglottic ductal cysts associated with complete tracheal ring deformity: coexistence of two rare airway abnormalities with fatal outcome. Pediatr Dev Pathol 2004; 7:273-6. [PMID: 15022057 DOI: 10.1007/s10024-003-0106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2003] [Accepted: 12/30/2003] [Indexed: 10/26/2022]
Abstract
Subglottic cysts are rare and may cause airway obstruction. Most cases are acquired secondary to endotracheal intubation, even short-term, particularly in the premature neonate. Complete tracheal rings are rare anomalies associated with tracheal stenosis. To our knowledge, the two have not been reported coexisting. A 16-month-old ex-premature boy was found unresponsive, with his tracheostomy tube dislodged. Tracheomalacia, subglottic stenosis, and a laryngeal cyst had been diagnosed shortly after birth, and the cyst was surgically treated at that time. At autopsy, a complete tracheal ring was noted in the subglottic region, above the tracheostomy site, and the tracheal diameter was markedly decreased in this area. In addition, multiloculated cysts were present at that level, arising from both anterolateral tracheal walls. These completely occluded the airway. To our knowledge, this is the first case of a combination of tracheal ring anomaly and subglottic cysts. Pediatric pathologists must be aware of iatrogenic lesions associated with care of the premature neonate, particularly as the age of viability continues to decrease.
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Affiliation(s)
- Aqiba Bokhari
- Department of Pathology and Laboratory Medicine, UH/E158, UMDNJ-New Jersey Medical School, 185 South Orange Avenue, P.O. Box 1709, Newark, NJ 07103, USA
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Lim J, Hellier W, Harcourt J, Leighton S, Albert D. Subglottic cysts: the Great Ormond Street experience. Int J Pediatr Otorhinolaryngol 2003; 67:461-5. [PMID: 12697347 DOI: 10.1016/s0165-5876(02)00406-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Subglottic cysts are a relatively rare, non-malignant cause of airway obstruction. In this study we reviewed the details of the patients who were treated for subglottic cysts in our department in order to evaluate the presentation and treatment of patients with this condition. METHODS We performed a retrospective case note analysis of 55 patients with subglottic cysts. Case notes were examined to determine the following details for each patient: date of birth, gestational age at birth, history and length of intubation, age at presentation, presenting symptoms, findings on endoscopy, treatment given for subglottic cysts, recurrence(s) of cysts after initial treatment, and follow up for a minimum of 6 months post diagnosis. RESULTS Fifty five patients were identified, 35 male, 20 female. Ninety four percent were born prematurely at 24-31 weeks gestation. All patients were intubated in the neonatal period. The median duration of intubation for all patients was 10 days (range 1-126). Fifty one patients underwent intervention for their subglottic cysts at their initial, diagnostic microlaryngoscopy and bronchoscopy (MLB), and recurrent cysts occurred in 22 cases. A total of 82 procedures for cyst removal were performed, using either the carbon dioxide laser or microinstruments. Subglottic stenosis was a commonly associated feature in our series of patients, being present in 38 patients. Eleven of the 14 patients who presented to our department with tracheostomies in situ were decannulated after removal of their subglottic cysts. CONCLUSIONS This review of the largest series of patients with subglottic cysts reported to date, reinforces our view that such cysts are rare but potentially reversible causes of upper airway obstruction, and that they result from injury to the larynx as a result of endotracheal intubation. Treatment of the cysts will often be sufficient to correct the obstructed airway allowing successful extubation or decannulation of a tracheostomy. Patients who have had subglottic cysts treated should have access to long-term follow up as there is a tendency for these cysts to recur.
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Affiliation(s)
- Jerome Lim
- Department of Otolaryngology, Great Ormond Street Hospital for Sick Children, London WC1N 3JH, UK.
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Smith OD, Callanan V, Lloyd-Thomas A, Albert DM. Pseudopolyp of the right laryngeal ventricle following atraumatic intubation: a diagnostic dilemma. Paediatr Anaesth 2000; 10:559-62. [PMID: 11012963 DOI: 10.1046/j.1460-9592.2000.00553.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The traumatic effects of tracheal intubation are well recognized. Whilst these usually follow prolonged intubation, acute lesions have been described, usually following a traumatic intubation technique. We present a case of acute, localized swelling of the right laryngeal ventricle which followed an entirely atraumatic intubation by an experienced paediatric anaesthetist. The lesion was not present at the time of intubation, but developed subsequently during the surgical procedure. Although previously observed at our institution, such lesions have not been described in the literature. The potential for a diagnostic pitfall, by mistaking the lesion for a laryngeal cyst or nodule, is discussed.
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Affiliation(s)
- O D Smith
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children NHS Trust, London, UK
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Holzki J, Laschat M, Stratmann C. Stridor in the neonate and infant. Implications for the paediatric anaesthetist. Prospective description of 155 patients with congenital and acquired stridor in early infancy. Paediatr Anaesth 1998; 8:221-7. [PMID: 9608967 DOI: 10.1046/j.1460-9592.1998.00233.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
One hundred-and-fifty-five neonates and infants up to the sixth month of postnatal age were investigated to reveal the cause of clinically relevant stridor. In 100 patients congenital stridor was found, in 55 children the stridor was considered to be acquired. A curled, soft epiglottis, almost synonymously used with the diagnosis of congenital stridor, was found in 7% only, indicating different methods of investigation and different selection of patients compared to previous years. In acquired stridor the majority of infants showed laryngeal and tracheal trauma, mostly due to the use of too large tracheal tubes.
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Affiliation(s)
- J Holzki
- Department of Paediatric Anaesthesia, Children's Hospital Cologne, Germany
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