Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Ste-Justine, Montreal, Quebec, Canada.
Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Laryngoscope. 2024 Jan;134(1):466-470. doi: 10.1002/lary.30813. Epub 2023 Jun 19.
Postoperative airway concerns persist despite a low rate of post-supraglottoplasty complications for children with laryngomalacia. The objective of this study is to determine the factors associated with the need for intensive care unit (ICU) admission following supraglottoplasty.
A 7-year retrospective cohort analysis was conducted between 2014 and 2021. A patient requiring ICU level of care was defined as the use of respiratory support such as intubation, positive pressure ventilation, high-flow nasal cannula, or multiple doses of nebulized epinephrine.
About 134 medical charts were reviewed; 12 patients were excluded because of concurrent surgery. Age at the time of surgery was 2.8 (4.3) months (median [interquartile range]). About 33 (27.0%) ultimately required ICU-level care. Prematurity (odds ratio [OR] 13.8), neurological condition (OR ∞), American Society of Anesthesiology class 3-4 (OR 6.5), and younger age (OR 1.8) were more likely to require ICU admission. No patient above 10 months of age needed ICU monitoring. The use of respiratory support justifying ICU was known within the first 4 h after surgery for almost all (32/33, 97%) of these patients. 4/33 (12.1%) were kept intubated and the remaining needed non-invasive ventilation. Only one patient (1/122, 0.8%) was reintubated 12 h after surgery for progressive respiratory distress.
Approximately a quarter of patients required ICU-level care after supraglottoplasty. For nearly all patients without comorbidities requiring ICU, this can be safely predicted within the first 4 h after surgery. Our data suggest that selected patients undergoing supraglottoplasty may be safely monitored outside of an ICU setting after an observation period in the post-anesthesia care unit.
4 Laryngoscope, 134:466-470, 2024.
尽管儿童喉软化症患者行杓状软骨成型术后并发症发生率较低，但仍存在气道相关的术后问题。本研究旨在确定与杓状软骨成型术后需要入住重症监护病房（ICU）相关的因素。
对 2014 年至 2021 年期间进行的一项 7 年回顾性队列分析。需要 ICU 级别的护理定义为需要使用呼吸支持，如插管、正压通气、高流量鼻导管或多次雾化肾上腺素。
共回顾了约 134 份病历，12 名患者因同时行其他手术而被排除。手术时的年龄为 2.8（4.3）个月（中位数[四分位间距]）。约 33 名（27.0%）患者最终需要 ICU 级别的护理。早产儿（比值比[OR] 13.8）、神经系统疾病（OR ∞）、美国麻醉师协会（ASA）分级 3-4 级（OR 6.5）和年龄较小（OR 1.8）的患者更有可能需要 ICU 入院。无 10 个月以上患儿需要 ICU 监测。几乎所有（33/33，97%）患者在术后 4 h 内即可明确需要使用何种呼吸支持来支持 ICU 治疗。33 名患者中 4 名（12.1%）需要插管，其余患者需要无创通气。只有 1 名患者（1/122，0.8%）因进行性呼吸窘迫在术后 12 h 再次插管。
约四分之一的杓状软骨成型术后患者需要 ICU 级别的护理。对于近所有无并发症需要入住 ICU 的患者，几乎都可以在术后 4 h 内进行预测。我们的数据表明，经过一段观察期后，在麻醉后护理单元，选择行杓状软骨成型术的患者可以安全地在 ICU 之外进行监测。
4 Laryngoscope, 134:466-470, 2024.
