Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Section of Respiratory Care, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan, ROC.
Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2018 Sep;81(9):804-810. doi: 10.1016/j.jcma.2018.03.008. Epub 2018 May 31.
Extubation failure (EF) in acute pediatric cases causes high morbidity and prolonged hospitalization, some of which might encounter EF repeatedly. This study aims to investigate flexible bronchoscopic findings of airway problems associated with repeated EF (REF) in children.
We retrospectively reviewed the medical records of intubated children from 2005 to 2013 and enrolled those with EF (reintubated within 48 h after extubation) and receiving flexible bronchoscopy (FB) examinations. We divided all subjects into two groups, the REF group (reintubated within 48 h after FB examination) and control group (no need of reintubation), and compared the related clinical conditions and outcomes.
We assessed 30 children (REF group, 17 cases; control group, 13 cases). Among them, no significant difference was observed in age, weight, and underlying diseases. In the REF group, the outpatient ratio, tracheostomy rate, intubation days, respiratory or oxygen supported days, and EF episodes were significantly higher than the control group (p < 0.05). Moreover, the FB findings in the REF group exhibited higher ratios of all airway problems and significantly in the presence of upper airway granulations (odds ratio [OR], 17.9, 95% confidence interval [CI]: 2.7-116.9) and subglottic stenosis (OR, 5.4; 95% CI: 1.1-26.0). After discharge, subjects of the REF group required higher medications than those in the control group (OR, 81.0; 95% CI: 3.9-1655.8).
Upper airway granulations or stenosis significantly augment the risk of REF in children; however, these could be diagnosed early by FB, guiding the therapeutic protocol in acute cases. Thus, anatomical problems of upper airways should be considered in intubated children with EF, and FB is a useful tool for the early diagnosis and management.
急性儿科病例中拔管失败（EF）会导致高发病率和延长住院时间，其中一些患者可能会反复出现 EF。本研究旨在探讨与儿童反复 EF（REF）相关的气道问题的软性支气管镜检查结果。
我们回顾性地审查了 2005 年至 2013 年期间插管的儿童的病历，并纳入了 EF（拔管后 48 小时内重新插管）并接受软性支气管镜（FB）检查的患者。我们将所有患者分为两组，REF 组（FB 检查后 48 小时内重新插管）和对照组（无需再次插管），并比较了相关的临床情况和结局。
我们评估了 30 名儿童（REF 组 17 例，对照组 13 例）。其中，年龄、体重和基础疾病无显著差异。REF 组中，门诊比例、气管切开率、插管天数、呼吸或吸氧天数和 EF 发作次数明显高于对照组（p < 0.05）。此外，REF 组的 FB 检查结果显示所有气道问题的比例较高，上气道肉芽组织（优势比 [OR]，17.9，95%置信区间 [CI]：2.7-116.9）和声门下狭窄（OR，5.4；95% CI：1.1-26.0）的存在更为显著。出院后，REF 组的患者比对照组的患者需要更高剂量的药物（OR，81.0；95% CI：3.9-1655.8）。
上气道肉芽组织或狭窄显著增加儿童 REF 的风险；然而，这些可以通过 FB 早期诊断，指导急性病例的治疗方案。因此，EF 伴插管的儿童应考虑上气道的解剖问题，FB 是早期诊断和管理的有用工具。
