Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China; Ear Institute, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, 1665 Kongjiang Road, Shanghai, 200092, China.
Int J Pediatr Otorhinolaryngol. 2020 Dec;139:110465. doi: 10.1016/j.ijporl.2020.110465. Epub 2020 Oct 23.
This study investigated the endoscopic findings associated with pediatric extubation failure (EF) and evaluated the prognosis of endoscopic procedures.
We retrospectively reviewed the data of children with EF in the intensive care unit from January 1, 2013 to December 31, 2019. Fifty-one children receiving endoscopic examination were enrolled in this study. EF was defined as the need for reintubation within 72 h of the first attempted extubation.
Thirty-three children (65%) were successfully extubated after endoscopic procedures, and 18 children (35%) failed in extubation. There was a higher percentage of children transferred from other hospitals with intubation in the failure group (56% vs 12%, p = 0.002). Subglottic stenosis (SGS) (35%) and laryngeal and tracheal granulation (33%) were two of the most common findings. Fourteen patients (82%) with granulation were successfully extubated. Two children in the failure group were diagnosed with mitochondrial myopathies (chrM:3243) and congenital myasthenic syndrome (CHAT). The success rate in cases of SGS reached 83% (15/18). Five patients diagnosed with laryngomalacia and another 3 patients with tracheomalacia failed extubation after supraglottoplasty and needed a temporary tracheostomy.
Granulation and subglottic stenosis were the leading causes of extubation failure. Patients transferred with intubation might have a poor prognosis after endoscopic procedures. Neuromuscular and metabolic disorders could be a hidden reason for extubation failure.
本研究调查了与小儿拔管失败（EF）相关的内镜检查结果，并评估了内镜检查的预后。
我们回顾性分析了 2013 年 1 月 1 日至 2019 年 12 月 31 日期间 ICU 中 EF 患儿的资料。本研究共纳入 51 例行内镜检查的 EF 患儿。EF 定义为首次尝试拔管后 72 h 内需要重新插管。
33 例（65%）患儿在接受内镜检查后成功拔管，18 例（35%）患儿拔管失败。失败组中更多患儿来自于其他医院并已插管（56%比 12%，p=0.002）。其中最常见的内镜检查结果是杓状软骨和声门下狭窄（35%）和喉气管肉芽组织（33%）。14 例（82%）肉芽组织患儿成功拔管。失败组中有 2 例患儿被诊断为线粒体肌病（chrM:3243）和先天性肌无力综合征（CHAT）。声门下狭窄的成功率达到 83%（15/18）。5 例诊断为喉软化的患儿和另外 3 例诊断为气管软化的患儿在接受会厌成形术后仍无法拔管，需要临时气管切开。
肉芽组织和声门下狭窄是导致拔管失败的主要原因。接受插管治疗的患儿行内镜检查后预后可能较差。神经肌肉和代谢紊乱可能是拔管失败的潜在原因。
