Walker P, Forte V
Department of Otolaryngology, Hospital for Sick Children, University of Toronto, Canada.
Ann Otol Rhinol Laryngol. 1993 Jul;102(7):489-95. doi: 10.1177/000348949310200701.
One of the roles of the pediatric otolaryngologist in the neonatal intensive care unit (NICU) is the assessment and management of the neonate who fails a trial of extubation. This paper reviews the recent 5-year institutional experience at The Hospital for Sick Children, Toronto, with neonates who failed extubation and who subsequently underwent diagnostic endoscopy. One hundred twenty-eight neonates from the NICU underwent diagnostic endoscopy. Of these, 58 neonates underwent diagnostic endoscopy for failure to extubate. Nine neonates were extubated after diagnostic endoscopy and retrial (16% of the series). Eleven neonates were extubated after additional endoscopic procedures (19% of the series). Twenty-four neonates underwent anterior cricoid split, of whom 20 or 83% (34% of the series) were eventually successfully extubated with no further airway intervention required during the study period (minimum 6 months' follow-up). Eleven neonates underwent tracheotomy (19% of the series). Four neonates underwent another external procedure to allow extubation (7% of the series). Three neonates died while still intubated (5% of the series). Our management of the neonate who fails a trial of extubation is discussed.
儿科耳鼻喉科医生在新生儿重症监护病房（NICU）的职责之一是对拔管试验失败的新生儿进行评估和管理。本文回顾了多伦多病童医院最近5年对拔管失败且随后接受诊断性内镜检查的新生儿的机构经验。128名来自NICU的新生儿接受了诊断性内镜检查。其中，58名新生儿因拔管失败接受了诊断性内镜检查。9名新生儿在诊断性内镜检查和再次试验后成功拔管（占该系列的16%）。11名新生儿在接受额外的内镜手术后成功拔管（占该系列的19%）。24名新生儿接受了环状软骨前部劈开术，其中20名（83%）最终成功拔管，在研究期间（至少6个月随访）无需进一步的气道干预（占该系列的34%）。11名新生儿接受了气管切开术（占该系列的19%）。4名新生儿接受了另一项外部手术以实现拔管（占该系列的7%）。3名新生儿在仍插管时死亡（占该系列的5%）。本文讨论了我们对拔管试验失败的新生儿的管理方法。
