The outcome of patients with upper airway obstruction transported to a regional paediatric intensive care unit

1998 ◽  
Vol 157 (11) ◽  
pp. 907-911 ◽  
Author(s):  
A. D. Durward ◽  
S. J. B. Nicoll ◽  
J. Oliver ◽  
S. M. Tibby ◽  
I. A. Murdoch
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Airway Obstruction ◽  
Paediatric Intensive Care Unit ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Paediatric Intensive Care

scholarly journals Surgical Versus Nonsurgical Interventions to Relieve upper Airway Obstruction in Children with Pierre Robin Sequence

2015 ◽  
Vol 22 (3) ◽  
pp. 171-175 ◽  
Author(s):  
Karen Kam ◽  
Meghan McKay ◽  
Joanna MacLean ◽  
Manisha B Witmans ◽  
Sheldon Spier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Pierre Robin Sequence ◽  
Pierre Robin

BACKGROUND: Newborns with Pierre Robin sequence (PRS) often experience chronic intermittent hypoxemia/hypoventilation associated with airway obstruction. The heterogeneity of the severity of upper airway obstruction makes management a challenge; the optimal intervention in individual cases is not clear.OBJECTIVE: To investigate the prevalence of surgical/nonsurgical interventions for PRS at two children’s hospitals. Patient characteristics and outcomes were examined.METHODS: The present retrospective chart review identified 139 patients with PRS born between 2000 and 2010. Demographic information, mode of airway management, associated anomalies and syndromes, polysomnography results, length of intensive care unit and hospital stay, complications and deaths were extracted.RESULTS: Interventions included prone positioning (alone [61%]), tongue-lip adhesion (45%), nasopharyngeal intubation (28%), continuous positive airway pressure (20%), tracheostomy (19%) and mandibular distraction osteogenesis (5%). Tracheostomies were more prevalent in syndromic patients (P=0.03). Patients who underwent tracheostomy had a lower birth weight (P=0.03) compared with newborns with other interventions. Patients who underwent surgical interventions had longer intensive care unit stays (P<0.001). No intervention was associated with a statistically significant likelihood of requiring a subsequent intervention. Thirty percent of patients underwent polysomnography, with a higher proportion of these using continuous positive airway pressure (n=15) (P<0.01).CONCLUSIONS: In the present descriptive study, patients with syndromic PRS or low birth weight underwent early intervention, which included a tracheostomy. Objective measures of airway obstruction were underutilized. Decision making regarding evaluation and management of upper airway obstruction in this population remains clinician and resource dependent. Reporting data obtained from a large cohort of PRS patients is important to compare experiences and motivate future studies investigating this complex condition.

scholarly journals Risk factors associated with symptoms of post-extubation upper airway obstruction in the emergency setting

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092636 ◽  
Author(s):  
Mafumi Shinohara ◽  
Masayuki Iwashita ◽  
Takeru Abe ◽  
Ichiro Takeuchi
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Airway Obstruction ◽  
Odds Ratio ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Laryngeal Edema ◽  
Female Sex

Objective Post-extubation stridor and hoarseness are important clinical manifestations that indicate laryngeal edema due to intubation. In previous studies the incidence of post-extubation stridor and hoarseness ranged from 1.5% to 26.3% in postoperative patients and patients in the intensive care unit. Female sex and prolonged intubation are reportedly risk factors for post-extubation stridor. However, the risk factors for post-extubation stridor and the appropriate endotracheal tube size in emergency settings remain unknown. This study was performed to identify the risk factors for post-extubation laryngeal edema after emergency intubation. Methods A prospective observational study was conducted in a tertiary emergency medical center/trauma center. The primary outcome was post-extubation stridor and hoarseness. Results During the study period, 482 emergency intubations and 227 extubations were performed in adult patients. In total, 29% of the patients presented symptoms of stridor and/or hoarseness. Female sex (odds ratio, 2.65; 95% confidence interval, 1.21–5.81) and the duration of intubation (odds ratio, 1.18; 95% confidence interval, 1.05–1.32) were associated with stridor and/or hoarseness. Conclusions Patients who undergo emergency intubation have a higher risk of post-extubation upper airway obstruction symptoms than postoperative patients and patients in the intensive care unit, and female sex is associated with these symptoms.

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