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Risk management protocol for gastrostomy and jejunostomy insertion in ventilator dependent infants

M Chatwin1, A Bush, D J Macrae

  • 1Clinical and Academic Department of Sleep and Breathing, Royal Brompton & Harefield NHS Foundation Trust, United Kingdom. m.chatwin@rbht.nhs.uk

Neuromuscular Disorders : NMD
|March 8, 2013
PubMed

Insights

Surgical interventions like gastrostomy and anti-reflux procedures in ventilator-dependent children are risky. However, careful pre-operative assessment and management in this high-risk cohort led to successful outcomes with early extubation and minimal complications.

Area of Science:

  • Pediatric Surgery
  • Critical Care Medicine
  • Gastroenterology

Background:

  • Gastrostomy, gastrojejunostomy, and anti-reflux surgery carry significant risks in chronically ventilator-dependent infants and children.
  • These procedures are often necessary for nutritional support and managing complications in this vulnerable population.

Purpose of the Study:

  • To evaluate the outcomes of high-risk, ventilator-dependent children undergoing gastrostomy, gastrojejunostomy, and anti-reflux surgery.
  • To assess the safety and efficacy of a specific pre-operative and post-operative management protocol.

Main Methods:

  • A cohort of 22 high-risk children requiring ventilatory support underwent 24 surgical procedures.
  • Pre-operative evaluation included cardiorespiratory monitoring, echocardiography, video fluoroscopy, and reflux assessment.
  • Procedures were performed under general anesthesia, followed by early extubation and aggressive airway clearance.

Main Results:

  • No post-operative mortality was observed.
  • 87% of children were successfully extubated within 24 hours.
  • Minor complications included atelectasis, ileus, abdominal distension, and loose stools.

Conclusions:

  • Careful pre-operative assessment and optimized ventilatory support enable safe surgical interventions in ventilator-dependent children.
  • Early extubation and aggressive airway management are feasible and associated with good outcomes.
  • This approach minimizes post-operative complications in high-risk pediatric surgical patients.

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