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Published on: January 17, 2011
Management of the Disrupted Airway in Children
Wei-Chung Hsu1,2, Claudia Schweiger1,3, Catherine K Hart1,4
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
Insights
Nonoperative management may lead to spontaneous healing in pediatric airway disruption cases without air extravasation. Surgical repair is considered for continuous air extravasation, especially when a cuffed tube cannot be placed distally.
Area of Science:
- Pediatric Otolaryngology
- Thoracic Surgery
- Pediatric Airway Management
Background:
- Airway disruption in children presents complex management challenges.
- Current guidelines for pediatric airway disruption are not specific.
- Establishing clear management protocols is crucial for optimal outcomes.
Purpose of the Study:
- To gather data for more specific management guidelines in pediatric airway disruption.
- To analyze factors influencing the management and outcomes of airway injuries in children.
Main Methods:
- Retrospective case series involving children under 18 with airway disruption.
- Data collected from five tertiary medical centers.
- Evaluation included flexible endoscopy and/or microlaryngoscopy; data on age, sex, etiology, injury type, management, and outcomes were summarized.
Main Results:
- Twenty children (mean age 4.4 years) were included.
- Tracheal involvement occurred in 12 (60%), bronchial in 7, and cricoid cartilage in 1.
- Nine children with air extravasation required surgery; only one of 11 without extravasation needed surgical repair. All cases healed completely.
Conclusions:
- Nonoperative management is viable for pediatric airway disruption without continuous air extravasation.
- Surgical repair is indicated for continuous air extravasation, particularly if distal tube placement is not feasible.
- Reduced risk of extravasation is noted in previously operated areas or with minimized positive pressure ventilation.
Objective:
Our objective was to gather data that would enable us to suggest more specific guidelines for the management of children with airway disruption.
Study Design:
Retrospective case series with data from five tertiary medical centers.
Methods:
Children younger than 18 years of age with a disrupted airway were enrolled in this series. Data pertaining to age, sex, etiology and location of the disruption, type of injury, previous surgery, presence of air extravasation, management, and outcome were obtained and summarized.
Results:
Twenty children with a mean age of 4.4 years (range 1 day-14.75 years) were included in the study. All were evaluated by flexible endoscopy and/or microlaryngoscopy in the operating room. Twelve (60%) children had tracheal involvement; seven had bronchial involvement; and one had involvement of the cricoid cartilage. Nine children had air extravasation, and all these children required surgical repair. Of the 11 who did not have air extravasation, only one underwent surgical repair. Complete healing of the disrupted airway was seen in all cases.
Conclusion:
This series suggests that if there is no continuous air extravasation demonstrated on imaging studies or clinical examination, nonoperative management may allow for spontaneous healing without sequelae. However, surgical repair may be considered in those patients with continuous air extravasation unless a cuffed tube can be placed distal to the site of injury. For children in whom airway injury occurs in a previously operated area, the risk of extravasation is reduced. This risk is also diminished if positive pressure ventilation can be avoided or minimized.
Level Of Evidence:
4 Laryngoscope, 131:921-924, 2021.
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