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Outcomes Using a Postoperative Protocol in Pediatric Single-Stage Laryngotracheal Reconstruction

Prasad John Thottam1, Taylor Gilliland2, Nicholas Ettinger3

  • 1Beaumont Children's Hospital, Royal Oak, MI, USA.

The Annals of Otology, Rhinology, and Laryngology
|February 16, 2019
PubMed

Insights

A new postoperative care protocol significantly improved outcomes for pediatric patients undergoing single-stage laryngotracheal reconstruction (ssLTR). The protocol reduced delayed extubation and intensive care unit stays, leading to more successful and timely extubation after ssLTR.

Area of Science:

  • Pediatric Otolaryngology
  • Surgical Critical Care
  • Airway Reconstruction

Background:

  • Single-stage laryngotracheal reconstruction (ssLTR) is a complex procedure for pediatric airway stenosis.
  • Postoperative care significantly influences outcomes, including extubation success and complication rates.
  • Standardized protocols may optimize recovery and reduce adverse events.

Purpose of the Study:

  • To evaluate the impact of a postoperative care protocol on outcomes of pediatric ssLTR.
  • To compare extubation success, intensive care unit (ICU) stay, and complication rates before and after protocol implementation.

Main Methods:

  • A case-control study comparing pediatric patients who underwent ssLTR with (protocol group) and without (control group) a postoperative care protocol.
  • Data collected from 2 tertiary academic centers (2010-2016) included perioperative management, planned extubation, ICU intubation duration, and complications.
  • Statistical analysis used chi-squared and Wilcoxon rank tests.

Main Results:

  • The protocol group (19 patients) showed a significantly lower rate of failed planned extubation (5% vs. 35% in the control group, P < .05).
  • Implementation of the structured protocol led to decreased delayed extubation and shorter ICU stays (P < .05).
  • Despite increased posterior graft placement in the protocol group, they were more likely to be extubated within 7 days (P < .05).

Conclusions:

  • An intensive care unit (ICU) protocol combining pharmacologic agents can reduce adverse events delaying extubation and decannulation.
  • A multidisciplinary approach involving otolaryngologists, pharmacists, intensivists, and anesthesiologists is key to timely extubation.
  • The proposed postoperative care protocol enhances the likelihood of successful and timely extubation following pediatric ssLTR.
Abstract

Keywords:
airway reconstructionchildintensive carelaryngeal stenosispediatric airwaytreatment outcomes

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