ABSTRACT
Introduction and objectives Airway injury caused by endotracheal intubation (ETI) is a common event in children who require ETI in the pediatric intensive care unit (PICU). The main aim of our study was to determine the incidence and the predisposing factors for the development of airway injury in PICU patients who need ETI. Secondary objectives were to evaluate the reasons for the request of airway endoscopy examination and the tracheostomy rate in this population. Materials and methods A retrospective, observational, descriptive study was conducted evaluating 1854 patients who were intubated in the PICU of a tertiary-care center between May 2015 and April 2019. Results The mean age of all intubated patients was 35.6 months and of those who required endoscopy 27.3 months (p = 0.04). Mean length of intubation was 7.2 days for all intubated patients and 23.5 days for those who required endoscopy (p = 0.0001). Extubation failure and stridor were significantly associated with the finding of airway injury (p = 0.0001 and p = 0.0006, respectively). Conclusions The incidence rate of ETI-related injury was 3%. Age younger than 27 months and intubation for more than 7 days were predisposing factors for the development of injury.The main indications for endoscopy were extubation failure and stridor, both related to the presence of injury. Tracheostomy rate in the PICU was 3.34%. (AU)
Introducción y objetivos Las lesiones de la vía aérea por intubación endotraqueal (IET) son procesos patológicos causados por el trauma de los tejidos durante dicha condición. El principal objetivo fue determinar la incidencia y los factores predisponentes para el desarrollo de lesión de la vía aérea en pacientes que requirieron IET en la Unidad de Terapia Intensiva Pediátrica (UTIP). Los objetivos secundarios fueron evaluar las indicaciones de endoscopía y el porcentaje de pacientes traqueostomizados en dicha población. Materiales y métodos Estudio retrospectivo, observacional y descriptivo, de 1854 pacientes intubados en un centro de tercer nivel de complejidad entre Mayo de 2015 y Abril de 2019.ResultadosLa media de edad de los pacientes intubados fue de 35,6 meses y la de los que requirieron endoscopía de la vía aérea fue de 27,3 meses (p = 0,04). El promedio de días de intubación de los pacientes intubados fue de 7,2 días y el de los que requirieron endoscopía fue de 23,5 días (p = 0,0001). El fallo de extubación programada y el estridor se relacionaron con la presencia lesión (p = 0,0001 y p = 0,0006, respectivamente). Conclusiones La incidencia de lesiones asociadas a la IET fue del 3%. La edad menor a 27 meses y la intubación por más de 7 días fueron los factores predisponentes para el desarrollo de lesiones. Las principales indicaciones de endoscopía fueron el fallo de extubación programada y el estridor; ambas se relacionaron con la presencia de lesión. El porcentaje de traqueostomías realizadas en la UTIP fue del 3,34%. (AU)
Subject(s)
Humans , Infant, Newborn , Respiratory System/injuries , Bronchoscopy , Intubation, Intratracheal/instrumentation , Pediatrics , Intensive Care Units , Retrospective Studies , Epidemiology, DescriptiveABSTRACT
PURPOSE: To report our experience and results in terms of complications, reoperation rate and urinary continence with the Salvage Continent Vesicostomy (SCV) technique in pediatric patients with history or need of enterocystoplasty and absent appendix. METHODS: Retrospective review of all patients with a history of a continent catheterizable channel surgery performed in our institution between June 2016 and January 2022. Only patients with a SCV surgery with a minimum 6-month post operative follow up were included in this cohort and divided in group 1 (history of previous bladder augmentation) and group 2 (simultaneous bladder augmentation and SCV). Primary outcome of the study was to assess both continence and postoperative complication rates. Early complications were assessed using the Clavien-Dindo classification (I-V). Late complications were focused on the need of further subfascial revision. RESULTS: 84 patients with a history of a continent stoma creation surgery were identified. In 20 of them (12 males) a SCV was performed. The mean age at surgery was 10.38 (range 4.87-15.6) years and the median postoperative follow-up time was 32 (range 6-64) months. Eleven patients were included in Group 1, while 9 patients in Group 2. Early complications occurred in 4 patients (20%), two of them required a re-intervention (Clavien-Dindo IIIb). Stoma subfascial revision was further required in 2 patient (10%). Continence rate at last follow up was 95%. CONCLUSIONS: In our early experience, the salvage continent vesicostomy has proven to be a simple continent stoma technique with acceptable both continence and complication rates that can be used in selected patients with a history or need of bladder augmentation and absent appendix.
Subject(s)
Plastic Surgery Procedures , Surgery, Plastic , Urinary Reservoirs, Continent , Male , Child , Humans , Infant , Cystostomy/methods , Urinary Reservoirs, Continent/adverse effects , Urologic Surgical Procedures , Retrospective Studies , Follow-Up StudiesABSTRACT
INTRODUCTION AND OBJECTIVES: Airway injury caused by endotracheal intubation (ETI) is a common event in children who require ETI in the pediatric intensive care unit (PICU). The main aim of our study was to determine the incidence and the predisposing factors for the development of airway injury in PICU patients who need ETI. Secondary objectives were to evaluate the reasons for the request of airway endoscopy examination and the tracheostomy rate in this population. MATERIALS AND METHODS: A retrospective, observational, descriptive study was conducted evaluating 1854 patients who were intubated in the PICU of a tertiary-care center between May 2015 and April 2019. RESULTS: The mean age of all intubated patients was 35.6 months and of those who required endoscopy 27.3 months (p = 0.04). Mean length of intubation was 7.2 days for all intubated patients and 23.5 days for those who required endoscopy (p = 0.0001). Extubation failure and stridor were significantly associated with the finding of airway injury (p = 0.0001 and p = 0.0006, respectively). CONCLUSIONS: The incidence rate of ETI-related injury was 3%. Age younger than 27 months and intubation for more than 7 days were predisposing factors for the development of injury. The main indications for endoscopy were extubation failure and stridor, both related to the presence of injury. Tracheostomy rate in the PICU was 3.34%.
