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The role of the anterior cricoid split in facilitating extubation in infants

N N Eze1, M E Wyatt, B E J Hartley

  • 1Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK. nnekaeze@yahoo.co.uk

International Journal of Pediatric Otorhinolaryngology
|May 12, 2005
PubMed

Insights

The anterior cricoid split (ACS) procedure successfully extubated 88% of infants with subglottic stenosis, avoiding tracheostomy. This safe intervention revolutionizes management for selected neonates with difficult extubation.

Area of Science:

  • Pediatric Otolaryngology
  • Respiratory Medicine
  • Surgical Innovation

Background:

  • Subglottic stenosis in infants often necessitates tracheostomy.
  • The anterior cricoid split (ACS) procedure offers an alternative for extubation.
  • Established criteria guide patient selection for ACS.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of the anterior cricoid split (ACS) procedure.
  • To assess the success rate of ACS in a tertiary referral center.
  • To determine the impact of ACS on tracheostomy rates in pediatric subglottic stenosis.

Main Methods:

  • Retrospective clinical study of 33 pediatric patients undergoing ACS between 1993-2004.
  • Inclusion criteria: infants with subglottic narrowing and failed extubation trials or persistent stridor.
  • Data collected: demographics, intubation duration, reintubations, success rates, and complications.

Main Results:

  • Successful extubation was achieved in 29 out of 33 (88%) children post-ACS.
  • Four patients (12%) failed extubation after the procedure.
  • Three of the four failures required tracheostomy; one remained intubated.

Conclusions:

  • The anterior cricoid split (ACS) procedure is a safe and effective treatment for selected neonates with early subglottic stenosis.
  • Successful ACS significantly increases extubation rates and avoids tracheostomy.
  • This procedure has revolutionized the management of pediatric subglottic stenosis.
Abstract

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