Korean J Otorhinolaryngol-Head Neck Surg.  2016 Jan;59(1):35-40. 10.3342/kjorl-hns.2016.59.1.35.

An Evaluation Protocol of the Upper Airway for Pediatric Patients with Stridor or Extubation Failure

• Park JO
• Park W
• Cho J
• Cho J
• Kim JK
• Jeong HS

• KMID: 2277941
• DOI: http://doi.org/10.3342/kjorl-hns.2016.59.1.35

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.

Keyword

Evaluation; Extubation failure; Pediatrics; Stridor; Upper airway

MeSH Terms

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