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[Non-invasive continuous positive airways pressure for post-extubation laryngitis in pediatric patients]
J A Rodríguez1, B Von Dessauer, G Duffau
1Facultad de Medicina. Universidad de Chile, Santiago-Chile. horrio@saval.cl
Insights
Post-extubation laryngeal edema (PLE) in children is common. Non-invasive CPAP significantly reduced treatment failure rates compared to conventional methods, offering a more effective therapy.
Area of Science:
- Pediatric Intensive Care
- Respiratory Medicine
- Critical Care Medicine
Background:
- Post-extubation laryngeal edema (PLE) is a frequent complication in pediatric intensive care units, affecting 10-15% of extubated children.
- Conventional treatments for PLE have reported high failure rates, necessitating exploration of alternative management strategies.
Purpose of the Study:
- To evaluate the efficacy of non-invasive continuous positive airway pressure (CPAP) in managing pediatric post-extubation laryngeal edema.
- To compare the failure rate of CPAP treatment with conventional management for PLE in children.
Main Methods:
- A randomized block design study was conducted, comparing conventional treatment (nebulized epinephrine and humidified oxygen) with non-invasive CPAP for 18 hours.
- The study aimed to enroll 25 patients to detect a significant difference between treatment groups, but was halted early due to emerging differences.
Main Results:
- Out of 270 extubated children, 28 developed PLE, with 25 meeting enrollment criteria. Thirteen received conventional therapy, and 12 received CPAP.
- Conventional therapy resulted in improvement in 38.5% of patients, while 91.7% of patients on CPAP improved (p = 0.01).
- Patients who failed conventional treatment and were subsequently treated with CPAP all improved, with one requiring re-intubation.
Conclusions:
- Non-invasive CPAP significantly reduces the failure rate of post-extubation laryngeal edema treatment in children compared to conventional therapy.
- CPAP demonstrated a 53.2% reduction in treatment failure rate, confirming its efficacy as a superior management option.
Unlabelled:
Post-extubation laryngeal edema (PLE) is a common complication (10-15%) in pediatric intensive care units, and some authors have reported high failure rates for conventional treatment.
Hypothesis:
Non-invasive continuous positive airways pressure (CPAP) in children with PLE may have a lower failure rate than conventional management.
Patients And Method:
Twenty-five patients were needed to detect a difference between the two treatment groups. The patients were assigned to receive the conventional treatment (nebulized epinephrin and humidified oxygen) or the experimental treatment (non-invasive CPAP treatment for 18 hours), using a randomized block design (10-patient blocks). After 9 months, the study was halted when a significant difference emerged between the two groups.
Results:
Of 270 children extubated during the study, 28 (10.3%) developed PLE and 25 met the enrollment requirements. Thirteen were assigned to conventional therapy and 12 to CPAP. General characteristics, time of intubation, FiO2 upon admission, use of corticoids before extubation and scores for respiratory difficulty upon admission were similar in the two groups (p > 0.05). With conventional therapy, 5 (38.5%) children improved and 8 patients worsened or remained the same. Eleven (91.7%) of the patients receiving CPAP improved (p = 0.01). Those who failed on conventional treatment were prescribed CPAP and all then improved, although one had to be re-intubated.
Conclusion:
The hypothesis was confirmed. CPAP treatment reduced the failure rate by 53.2% in comparison with conventional therapy.