Position paper of diagnosis and treatment of post-extubation laryngitis in children: a multidisciplinary expert-based opinion.

OBJECTIVES: To make recommendations on the diagnosis and treatment of post-extubation laryngitis (PEL) in children with or without other comorbidities. METHODS: A three-iterative modified Delphi method was applied. Specialists were recruited representing pediatric otolaryngologists, pediatric and neonatal intensivists. Questions and statements approached topics encompassing definition, diagnosis, endoscopic airway evaluation, risk factors, comorbidities, management, and follow-up. A consensus was defined as a supermajority >70%. RESULTS: Stridor was considered the most frequent symptom and airway endoscopy was recommended for definitive diagnosis. Gastroesophageal reflux and previous history of intubation were considered risk factors. Specific length of intubation did not achieve a consensus as a risk factor. Systemic corticosteroids should be part of the medical treatment and dexamethasone was the drug of choice. No consensus was achieved regarding dosage of corticosteroids, although endoscopic findings help defining dosage and length of treatment. Non-invasive ventilation, laryngeal rest, and use of comfort sedation scales were recommended. Indications for microlaryngoscopy and bronchoscopy under anesthesia were symptoms progression or failure to improve after the first 72-h of medical treatment post-extubation, after two failed extubations, and/or suspicion of severe lesions on flexible fiberoptic laryngoscopy. CONCLUSIONS: Management of post-extubation laryngitis is challenging and can be facilitated by a multidisciplinary approach. Airway endoscopy is mandatory and impacts decision-making, although there is no consensus regarding dosage and length of treatment.

Position paper of diagnosis and treatment of post-extubation laryngitis in children: a multidisciplinary expert-based opinion

Abstract Objectives To make recommendations on the diagnosis and treatment of post-extubation laryngitis (PEL) in children with or without other comorbidities. Methods A three-iterative modified Delphi method was applied. Specialists were recruited representing pediatric otolaryngologists, pediatric and neonatal intensivists. Questions and statements approached topics encompassing definition, diagnosis, endoscopic airway evaluation, risk factors, comorbidities, management, and follow-up. A consensus was defined as a supermajority >70%. Results Stridor was considered the most frequent symptom and airway endoscopy was recommended for definitive diagnosis. Gastroesophageal reflux and previous history of intubation were considered risk factors. Specific length of intubation did not achieve a consensus as a risk factor. Systemic corticosteroids should be part of the medical treatment and dexamethasone was the drug of choice. No consensus was achieved regarding dosage of corticosteroids, although endoscopic findings help defining dosage and length of treatment. Non-invasive ventilation, laryngeal rest, and use of comfort sedation scales were recommended. Indications for microlaryngoscopy and bronchoscopy under anesthesia were symptoms progression or failure to improve after the first 72-h of medical treatment post-extubation, after two failed extubations, and/or suspicion of severe lesions on flexible fiberoptic laryngoscopy. Conclusions Management of post-extubation laryngitis is challenging and can be facilitated by a multidisciplinary approach. Airway endoscopy is mandatory and impacts decision-making, although there is no consensus regarding dosage and length of treatment.

Ongoing Laryngeal Stenosis: Conservative Management and Alternatives to Tracheostomy.

Background: Following tracheal intubation, some children may develop stridor, which is an indication of an obstructive lesion in the airway, such as an ongoing laryngeal stenosis (LS). This review focuses on evaluation of stridor and possible endoscopic predictors of progression to LS and, once post-intubation acute lesions are established, therapeutic choices to manage this disorder in avoidance of tracheostomy. Tracheostomy, due to its inherent increased morbidity, mortality and influence on social stigma, should be viewed only as a last resort. In this article, available conservative and alternative therapies for ongoing LS are thoroughly reviewed. Methods: A systematic review concerning randomized clinical trials and prospective studies on treatment modalities for LS was performed. A search strategy was developed for MEDLINE comprising terms related to disease, intervention and population. Title and abstract from captured references were peer-reviewed for eligibility. Selected studies full-texts were peer-reviewed and the results were compiled in a structured and narrative review. Stridor evaluation and post-extubation acute lesion classification were studied. Treatments such as balloon dilation, rigid dilation, corticosteroid-coated small tube intubation, and corticosteroid nebulization were described and evidence supporting their usage was discussed.

Endoscopia de urgencia en pacientes con episodio agudo de sangrado digestivo alto / Emergency endoscopy in patients with acute episode of high digestive bleeding

Se realizó un estudio descriptivo y transversal para caracterizar a 48 pacientes con sangrado digestivo alto, confirmado mediante endoscopia de urgencia por vía oral en el Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero hasta agosto de 2012. En la casuística predominaron el sexo masculino (66,7 por ciento), el grupo etario de 51 a 70 años (47,9 por ciento), así como el diagnóstico de enfermedad ulcerosa péptica (66,7 por ciento), seguida en menores porcentajes por las lesiones agudas de la mucosa gástrica y la rotura de várices esofágicas. Se aplicó tratamiento endoscópico en 27,1 por ciento de los integrantes de la serie, ninguno de los cuales presentó complicaciones atribuibles al procedimiento. La endoscopia de urgencia es la técnica de elección para diagnosticar y tratar precozmente afecciones hemorrágicas del trato digestivo superior, lo cual influirá de manera determinante en la no recurrencia de la hemorragia y en la disminución de la mortalidad por esa causa

A descriptive and cross-sectional study was carried out to characterize 48 patients with high digestive bleeding, confirmed through an oral emergency endoscopy in the General Teaching Hospital Dr Juan Bruno Zayas Alfonso in Santiago de Cuba, from January to August of 2012. Male sex (66.7 percent), the age group 51 to 70 years (47.9 percent), as well as the diagnosis of peptic ulcerous disease (66.7 percent), followed in lower percentages by acute lesions of the gastric mucous and the rupture of esophageal varices prevailed in the case material. Endoscopic treatment was applied in 27.1 percentof the patients, none of whom presented with complications attributable to the procedure. Emergency endoscopy is the choice technique to diagnose and treat early hemorrhagic affections from the high digestive tract, what will decisively influence in no recurrence of hemorrhage and in the decrease of mortality due to that cause