Faculty Collaboration Database

The direct laryngoscopy and rigid bronchoscopy findings and the subsequent management of infants with failed extubations. Int J Pediatr Otorhinolaryngol 2020 Nov;138:110268

Date

08/18/2020

Pubmed ID

32805493

DOI

10.1016/j.ijporl.2020.110268

Scopus ID

2-s2.0-85089368065 (requires institutional sign-in at Scopus site)

Abstract

INTRODUCTION: There is limited data regarding the role of direct laryngoscopy and rigid bronchoscopy (DLRB) in infants with failed extubations. Pediatric otolaryngologists are frequently consulted to perform DLRB in infants with failed extubations.

OBJECTIVE: To determine the DLRB findings in infants with failed extubations and the interventions performed based on these findings.

METHODS: A retrospective chart review was performed on infants less than 12 months old undergoing DLRB for failed extubations from January 2013-June 2017 at a tertiary care children's hospital. Data was collected on age, birth weight, perinatal complications, comorbid conditions, number of failed extubations, length of most recent intubation, operative findings, and subsequent interventions, including tracheostomy. Descriptive and comparative analyses were performed.

RESULTS: Of the 62 subjects who met study criteria, median age at DLRB was 3.0 months, corrected age was 1.0 months, gestational age was 27.1 weeks, birth weight was 0.97 kg, and number of failed extubations was 2.0. About 80% had respiratory distress at birth requiring intubation, and 76% carried a diagnosis of bronchopulmonary dysplasia (BPD). The median number of days intubated prior to DLRB was 27. Twenty-seven percent of subjects had no significant abnormal findings on DLRB, and 26% had subglottic stenosis. The majority (74%) underwent tracheostomy. Eighteen percent of subjects had an initial intervention for abnormal DLRB finding(s) other than tracheostomy and were able to avoid tracheostomy as a future intervention. Tracheostomy placement was associated with a diagnosis of BPD (RR 1.78, 95% CI 1.02, 3.10), having a birth weight less than 0.71 kg (RR 1.45, CI 1.01, 2.10), and being intubated for 48 or more days prior to DLRB (RR 1.57, 95% CI 1.05, 2.36); it was not associated with the number of failed extubations prior to DLRB.

CONCLUSIONS: Infants with failed extubations commonly had abnormal findings on airway evaluation by DLRB. Most children in this population still required tracheostomy placement, but about 20% were able to have an alternate intervention and avoid tracheostomy.

Author List

Espahbodi M, Kallenbach SL, Thorgerson AA, Huang CC, Shay SG, McCormick ME, Chun RH

Authors

Robert H. Chun MD Professor in the Otolaryngology department at Medical College of Wisconsin
Michael E. McCormick MD Associate Professor in the Otolaryngology department at Medical College of Wisconsin
Sophie G. Shay MD Assistant Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Airway Extubation
Birth Weight
Bronchopulmonary Dysplasia
Bronchoscopy
Female
Gestational Age
Humans
Infant
Infant, Newborn
Intubation, Intratracheal
Laryngoscopy
Laryngostenosis
Male
Respiratory Distress Syndrome, Newborn
Retrospective Studies
Time Factors
Tracheostomy