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Prevalence and risk factors for upper airway obstruction after pediatric cardiac surgery
Jack Green1, Henry L Walters2, Ralph E Delius2
1Department of Pediatrics, Children's Hospital of Michigan/Wayne State University School of Medicine, Detroit, MI.
Insights
Extrathoracic upper-airway obstruction affects 16% of pediatric cardiac surgery patients. Difficulty calming patients during mechanical ventilation, particularly with dexmedetomidine or vecuronium, is a key risk factor.
Area of Science:
- Pediatric Cardiac Surgery
- Intensive Care Medicine
- Respiratory Physiology
Background:
- Extrathoracic upper-airway obstruction is a potential complication following pediatric cardiac surgery.
- Identifying risk factors is crucial for improving patient outcomes and guiding clinical practice.
Purpose of the Study:
- To determine the prevalence of extrathoracic upper-airway obstruction in pediatric patients post-cardiac surgery.
- To identify independent risk factors associated with this complication.
Main Methods:
- Retrospective chart review of 213 pediatric patients (<18 years) undergoing cardiac surgery.
- Definition of clinically significant upper-airway obstruction included postextubation stridor with corticosteroid use, helium-oxygen therapy, or reintubation.
- Multivariate logistic regression analysis to identify independent risk factors.
Main Results:
- The prevalence of extrathoracic upper-airway obstruction was 16% (35 patients).
- Factors associated with obstruction included greater surgical complexity, higher vasoactive medication needs, and longer endotracheal intubation duration.
- Adjunctive use of dexmedetomidine or vecuronium was independently associated with upper-airway obstruction (OR 3.4, 95% CI 1.4-8).
Conclusions:
- Extrathoracic upper-airway obstruction is a common complication after pediatric cardiac surgery.
- Children who are difficult to calm during endotracheal intubation are at higher risk.
- Postoperative upper-airway obstruction warrants consideration as an outcome measure in sedation practice studies.
Objective:
To determine the prevalence of and risk factors for extrathoracic upper-airway obstruction after pediatric cardiac surgery.
Study Design:
A retrospective chart review was performed on 213 patients younger than 18 years of age who recovered from cardiac surgery in our multidisciplinary intensive care unit in 2012. Clinically significant upper-airway obstruction was defined as postextubation stridor with at least one of the following: receiving more than 2 corticosteroid doses, receiving helium-oxygen therapy, or reintubation. Multivariate logistic regression analysis was performed to determine independent risk factors for this complication.
Results:
Thirty-five patients (16%) with extrathoracic upper-airway obstruction were identified. On bivariate analysis, patients with upper-airway obstruction had greater surgical complexity, greater vasoactive medication requirements, and longer postoperative durations of endotracheal intubation. They also were more difficult to calm while on mechanical ventilation, as indicated by greater infusion doses of narcotics and greater likelihood to receive dexmedetomidine or vecuronium. On multivariable analysis, adjunctive use of dexmedetomedine or vecuronium (OR 3.4, 95% CI 1.4-8) remained independently associated with upper-airway obstruction.
Conclusion:
Extrathoracic upper-airway obstruction is relatively common after pediatric cardiac surgery, especially in children who are difficult to calm during endotracheal intubation. Postoperative upper-airway obstruction could be an important outcome measure in future studies of sedation practices in this patient population.
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