Agar Nicholas J M, Berkowitz Robert G
Department of Otolaryngology, Royal Children's Hospital, Melbourne, Australia.
Ann Otol Rhinol Laryngol. 2011 Jun;120(6):353-7. doi: 10.1177/000348941112000601.
Prolonged intubation is a risk factor for the development of laryngotracheal stenosis. Children who undergo extracorporeal membrane oxygenation (ECMO) usually remain intubated for an extended period. It is unclear whether the impaired cardiorespiratory status that necessitated ECMO places these children at a higher risk of laryngotracheal stenosis. This study was performed to assess the incidences of laryngotracheal stenosis and tracheostomy in children who undergo ECMO.
We identified all patients under 18 years of age who underwent ECMO over a 10-year period concluding July 1, 2009, by use of the extracorporeal life support database of Royal Children's Hospital, Melbourne. All children in this database who underwent either a diagnostic or a therapeutic surgical procedure on the airway were identified.
The 218 patients included in the study had an overall survival rate of 51.4%. A total of 14 patients (6.4%) required a surgical procedure on the airway, and 11 of these (5.0%) needed tracheostomy. Ten of these 14 patients (71.4%) survived; of these, 2 presented with congenital laryngotracheal stenosis, 3 developed clinically significant laryngotracheal stenosis as a likely consequence of ECMO, and 5 required tracheostomy alone for long-term ventilation. The rate of airway stenosis was 2.7% in survivors.
The rate of laryngotracheal stenosis in children who require ECMO is acceptably low.
长时间插管是喉气管狭窄发生的一个危险因素。接受体外膜肺氧合（ECMO）的儿童通常需要长时间插管。尚不清楚需要ECMO的心肺功能受损状况是否会使这些儿童发生喉气管狭窄的风险更高。本研究旨在评估接受ECMO的儿童喉气管狭窄和气管切开术的发生率。
我们利用墨尔本皇家儿童医院的体外生命支持数据库，确定了在截至2009年7月1日的10年期间接受ECMO的所有18岁以下患者。确定了该数据库中所有接受气道诊断性或治疗性外科手术的儿童。
纳入研究的218例患者的总生存率为51.4%。共有14例患者（6.4%）需要进行气道外科手术，其中11例（5.0%）需要气管切开术。这14例患者中有10例（71.4%）存活；其中，2例患有先天性喉气管狭窄，3例因ECMO可能导致临床上显著的喉气管狭窄，5例仅因长期通气需要气管切开术。幸存者中气道狭窄发生率为2.7%。
需要ECMO的儿童喉气管狭窄发生率低至可接受水平。
