| 11 th Annual Pediatric Critical Care Colloquium |
| Session/Time | Pulmonary I/Thu, 9:45 - 12 00 PM |
| Title | Factors Influencing Post-Extubation Upper Airway Obstruction in Children |
| Author | T Heiler, G Bar-Joseph, R Beck |
| Affiliation | Pediatric Intensive Care, Rambam Medical Center and the Faculty of Medicine, Technion, Haifa, Israel |
| Introduction | Young cmdren seem to tolerate prolonged endotracheal (ET) intubation better tl= older children and adults. Hence, early, tracheostomy is not a common practice in children. Predisposing factors to developing upper airway obstruction (UAO) following incubation include traumatic intubation, inappropriate tube size, movement of the ET tube within the larynx, infections and more. In adults, severe head injury was shown to be a risk factor for the development of UAO after incubation. The objective of this study was to retrospectively analyze factors associated with post extubation UAO in children, with special attention on the effect of the primary cause of admission on the development of UAO. |
| Method | All charts of patients admitted during 1992-1996 to the PICU at Rambam, a regional referral center, were re-viewed. Included were patients who were intubated for longer than 24 hrs. Patients with primary injury or lesion involving the face and upper airways were excluded. Multiple factors related to the intubation and cxtubation procedures, the clinical course and post-extubation airway patency were recorded. Patients were divided according to admission diagnoses into 3 groups: Gr.1 - head trauma, Gr.2- non-traumatic neurological problem and Gr.3 - no neurological problem. Outcome variables were post-extubation stridor, need for re-intubation or tracheostomy and subglottic stenosis. Chi square or Fisher's test, ANOVA and t-test Nvere used as appropriate and risk factors Nvere calculated. |
| Result | 305 patients, 0-13 years of age, were included. Major results are summarized in the table (numbers not always add up to total group number due to missing data). |
 Children
who were inhibited for head trauma were at significantly higher risk to develop '
severe UAO post extubation. 10% of head trauma patients required re-intubation and
8% failed at least one extunation and required tracheostomy for subglottic stensis. These
children also had higher proportion of field intubations, although further analysis did
not find field intubation to be an independent risk factor. |
Use your browser's back button to return to the appropriate index of abstracts...
Back to PCCC 98 Abstract Introduction | Back to PCCC 1998