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Tracheobronchial intubation using flexible bronchoscopy in children with Pierre Robin sequence: Nursing

Ying-Long Ye¹, Cai-Feng Zhang¹, Li-Zhen Xu¹

¹Department of Respiratory Medicine, Guangzhou Women and Children's Medical Centre, Guangzhou 510623, Guangdong Province, China.

World Journal of Clinical Cases

|August 18, 2022

Insights

Flexible bronchoscopy (FB) ensures successful tracheobronchial intubation (TI) in children with Pierre Robin sequence (PRS). Careful attention to intubation technique is crucial to prevent complications like laryngeal edema.

Area of Science:

Pediatric Anesthesiology
Airway Management
Surgical Complications

Background:

Children with Pierre Robin sequence (PRS) face elevated risks of difficult intubation.
Flexible bronchoscopy (FB) is a valuable tool for guiding tracheobronchial intubation (TI) in challenging pediatric airways.

Purpose of the Study:

To assess complications associated with FB-guided TI in pediatric PRS patients.
To explore the impact of nursing interventions on postoperative complications.

Main Methods:

A study involving 105 children with PRS undergoing FB-guided TI before mandibular distraction osteogenesis.
A control group of 108 children with common pneumonia and no difficult airway was included for comparison.
Key metrics included TI success rates, time, attempts, and postoperative complication incidence.

Main Results:

FB-guided TI achieved a 100% success rate in children with PRS.
The PRS group experienced a higher incidence of complications (47.6%) compared to the control group (33.3%), including a notable increase in laryngeal edema (6.7%).
While TI success was high, the PRS group required more attempts and longer intubation times.

Conclusions:

Flexible bronchoscopy (FB) is effective for high-success tracheobronchial intubation (TI) in children with Pierre Robin sequence (PRS).
Preventing laryngeal edema necessitates careful consideration of catheter material, lubrication, and intubation duration.

Read full analysis

Abstract

Background:

It has been shown that children with Pierre Robin sequence (PRS) have a higher risk of difficult intubation before surgery. When mask ventilation or tracheobronchial intubation is expected to be challenging, flexible bronchoscopy (FB) is advantageous in airway safety when it is used to guide tracheobronchial intubation (TI).

Aim:

To evaluate the complications of TI using FB in children with PRS and explore the effect of nursing services on postoperative complications.

Methods:

One hundred and five children with PRS underwent TI using FB before early mandibular distraction osteogenesis. One hundred and eight children with common pneumonia who did not have a difficult airway were set as the control group. Demographic data, success rates of TI, time required for TI, number of TI attempts, and the incidence of postoperative complications were assessed. Besides, the strategies used to attenuate complications were investigated.

Results:

The success rate of TI was 100% in children with PRS, while the success rate at the first attempt in the PRS group was significantly lower than that in the control group (88.6% vs 98.2%, P = 0.005). The time required for TI in the PRS group was markedly longer than that in the control group (P < 0.001). Children in the PRS group required repetitive operations to enter the glottis successfully (P = 0.017). The incidence of complications was noticeably higher in the PRS group (50/105, 47.6%) than in the control group (36/108, 33.3%) (P = 0.034). Seven of 105 PRS children experienced laryngeal edema (LE) (6.7%), compared with one (0.9%) in the control group (P = 0.034). Out of the seven patients who had LE, all were reintubated and managed with steroids: six recovered with inhaled steroids alone before extubated, and one was given systemic corticosteroids before recovery.

Conclusion:

FB contributes to a high success rate of TI in children with PRS. To prevent LE, operators should pay more attention to catheter material, catheter lubrication and intubation time.

Keywords:

Clinical nursing Operating room Patient safety Pediatrics Surgical nursing

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