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Functional assessment of the paediatric laryngeal airway
D B Kearns1, D M Albert, D I Choa
1Department of Otolaryngology, Hospital for Sick Children, London, UK.
Insights
Measuring upper airway resistance in children with tracheostomies can predict decannulation success. This method helps identify children likely to face difficulties, improving patient outcomes.
Area of Science:
- Pediatric pulmonology
- Respiratory medicine
- Medical device engineering
Background:
- Decannulation after tracheostomy in children can be challenging, leading to significant morbidity.
- While anatomical issues are identifiable via endoscopy and radiography, physiological abnormalities are harder to assess.
Purpose of the Study:
- To develop and evaluate a system for calculating functional upper airway resistance in children with tracheostomies.
- To assess the correlation between upper airway resistance and successful decannulation in pediatric patients.
Main Methods:
- Utilized a modified Mercury Electronics rhinomanometer with probes placed through the tracheostome and an anesthetic face mask.
- Recorded differential pressure and flow changes in spontaneously breathing, anesthetized children.
- Calculated functional upper airway resistance based on recorded data.
Main Results:
- Studies involving 26 children demonstrated low upper airway resistance in all successfully decannulated patients.
- The developed system effectively measured upper airway resistance in the pediatric cohort.
Conclusions:
- Functional upper airway resistance measurement is a viable method for assessing decannulation potential in children.
- This technique may help identify children at risk for decannulation difficulties, enabling proactive management.
Abstract:
After resolution of conditions necessitating tracheostomy in children, decannulation may be extremely difficult and associated with significant morbidity. Endoscopy and radiography can identify anatomical abnormalities preventing decannulation. Physiological abnormalities are, however, more difficult to assess. A system has been developed whereby functional upper airway resistance can be calculated in children with a tracheostomy. The instrument used was a modified Mercury Electronics rhinomanometer. A probe was placed through the tracheostome and another probe was situated in an occluding anaesthetic face mask. Upper airway resistance was derived from the differential pressure and flow changes recorded in anaesthetized children who were breathing spontaneously. Studies in 26 children have revealed low airway resistance in all those successfully decannulated. Further studies will hopefully allow identification in advance of children who will have decannulation difficulties.