From the Division of Plastic Surgery, Children's Hospital of Philadelphia.
Plast Reconstr Surg. 2019 Jun;143(6):1725-1736. doi: 10.1097/PRS.0000000000005651.
The frequency of respiratory events in the perioperative period, and optimal duration of intubation during early mandibular distraction osteogenesis activation, are poorly understood. This study assesses potential risk factors associated with perioperative respiratory events, particularly the need for reintubation, following mandibular distraction osteogenesis surgery.
A retrospective review was conducted for infants (younger than 1 year) undergoing mandibular distraction osteogenesis for tongue-based airway obstruction between November of 2010 and December of 2017. Univariate and multivariate analyses of sentinel events and outcomes were performed.
Ninety infants (median age, 35 days) were included (50 percent were syndromic). Twenty-seven subjects (30 percent) experienced a respiratory event requiring intervention before discharge, including 14 subjects who failed initial extubation. Subjects extubated earlier than postoperative day 5 failed extubation more frequently (33%) compared to those extubated later (9%; p = 0.005). Respiratory events occurred more frequently when extubation was attempted at distraction lengths of 5 mm or less (42 percent) compared to greater than 5 mm (21 percent; p = 0.032). Logistic regression modeling showed that syndromic status (OR, 14.8) and secondary airway anomaly (OR, 6.1) were significant predictors for respiratory events, whereas greater length of distraction at the time of extubation was protective (OR, 0.8; p < 0.05).
Postoperative intubation of at least 5 days with associated mean distraction of 5 mm appears to be associated with successful extubation trial following mandibular distraction osteogenesis surgery. Patients with congenital syndromes and secondary airway anomalies are more likely to experience perioperative respiratory events.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
围手术期呼吸事件的频率以及下颌骨牵引成骨术早期激活期间插管的最佳持续时间尚未完全了解。本研究评估了与下颌骨牵引成骨术后围手术期呼吸事件相关的潜在危险因素，尤其是再次插管的必要性。
对 2010 年 11 月至 2017 年 12 月期间因舌基气道阻塞而行下颌骨牵引成骨术的婴儿（<1 岁）进行了回顾性研究。对哨兵事件和结局进行了单变量和多变量分析。
共纳入 90 例婴儿（中位年龄 35 天）（50%为综合征）。27 例（30%）在出院前出现需要干预的呼吸事件，其中 14 例初次拔管失败。与术后第 5 天以后拔管的患者相比，更早拔管的患者（33%）拔管失败的频率更高（9%；p=0.005）。当尝试在 5mm 或更小时（42%）而不是大于 5mm 时（21%）进行拔管时，呼吸事件更频繁（p=0.032）。Logistic 回归模型显示，综合征状态（OR，14.8）和次要气道异常（OR，6.1）是呼吸事件的显著预测因子，而在拔管时的牵引长度更长则是保护性的（OR，0.8；p<0.05）。
在下颌骨牵引成骨术后，至少 5 天的术后插管，同时伴有 5mm 的平均牵引，似乎与下颌骨牵引成骨术后成功的拔管试验相关。有先天性综合征和次要气道异常的患者更有可能发生围手术期呼吸事件。
临床问题/证据水平：风险，III。
