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Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways
Published on: April 7, 2023
Primary aerodigestive presentations of Pierre Robin sequence/complex and predictive factors of airway type and
Nirupan Vipulananthan1, Timothy Cooper2, Manisha Witmans3
1Faculty of Medicine and Dentistry, University of Alberta Hospitals & Stollery Children's Hospital, Edmonton, Alberta, Canada.
Insights
Many children with Pierre Robin sequence/complex (PRS/C) present later than neonates, often with issues other than respiratory failure. Male gender and respiratory failure at presentation predict severe airway obstruction and tracheostomy needs in PRS/C patients.
Area of Science:
- Pediatric Otolaryngology
- Craniofacial Anomalies
- Airway Management
Background:
- Pierre Robin sequence/complex (PRS/C) is a congenital condition characterized by micrognathia, glossoptosis, and airway obstruction.
- Early identification and management are crucial for improving outcomes in affected children.
- Understanding presentation patterns and predictive factors can optimize care.
Purpose of the Study:
- To document the age and mode of initial aerodigestive presentation of children with PRS/C to otolaryngologists.
- To identify factors that predict the type of upper airway obstruction and subsequent management needs.
Main Methods:
- Retrospective cohort study at a tertiary pediatric referral center.
- Analysis of a surgical database for children diagnosed with PRS/C.
- Data collected included demographics, presenting complaints, diagnoses, airway obstruction type, airway lesions, cleft palate presence, and interventions; regression analysis was used for prediction.
Main Results:
- Forty-six children with PRS/C were included, with a mean age at presentation of 20.4 months.
- Respiratory failure was the primary presentation in 23 patients, followed by sleep-disordered breathing (14) and swallowing dysfunction (9).
- Later presentation (non-respiratory failure) and overt cleft palate were associated with respiratory failure; male gender and respiratory failure predicted more severe airway obstruction and tracheostomy.
Conclusions:
- A significant proportion of PRS/C patients present after the neonatal period with non-respiratory failure symptoms.
- Male gender and presenting with respiratory failure are indicators of more severe upper airway obstruction and a higher likelihood of requiring tracheostomy.
Objective:
To document the mode and age of primary aerodigestive presentation of Pierre Robin sequence/complex (PRS/C) children to the otolaryngologist and to explore predictive factors of upper airway type and management.
Methods:
This is a retrospective cohort study conducted in a tertiary pediatric referral center. A prospective surgical database was searched for children who were diagnosed with PRS/C. Demographics, presenting complaint, secondary diagnoses, type of upper airway obstruction, secondary airway lesions, presence of cleft palate, and airway interventions were collected. Multiple linear regression analysis was performed to predict upper airway obstruction type and intervention.
Results:
Seventy-seven potentially eligible patients were identified. Forty-six were included (20 females). Mean age at presentation was 20.4±36.9 months (range 1-191.25 months). Twenty-three primarily presented with respiratory failure, 14 with sleep disordered breathing, and nine with swallowing dysfunction. Children with presentations other than respiratory failure were older (p=0.004). Nineteen were syndromic. Overt cleft palate was more common in those presenting with respiratory failure (p=0.01). The type of airway obstruction encountered and use of tracheostomy were positively predicted by the primary presenting feature of respiratory failure (p<0.05) and male gender (p<0.05).
Conclusion:
A substantial number of PRS/C patients present later than the neonatal period with presentations other than respiratory failure. Both male gender and presentation with respiratory failure predicted a more severe airway obstruction type and the need for trachesotomy.
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