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Published on: January 17, 2011
Flowchart for selecting an appropriate surgical airway in neurologically impaired pediatric intubated patients: a
Mitsuyoshi Imaizumi1, Kazuhide Suyama2, Aya Goto3
1Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan.
Insights
A new flowchart aids in selecting surgical airways for neurologically impaired pediatric patients requiring long-term ventilation. This tool improves decision-making and satisfaction for both medical professionals and caregivers.
Area of Science:
- Pediatric critical care medicine
- Surgical airway management
Background:
- Increased survival of neurologically impaired children necessitates long-term mechanical ventilation and tracheostomy.
- A lack of consensus exists regarding optimal timing and methods for surgical airway placement in these vulnerable patients.
Purpose of the Study:
- To develop and evaluate a flowchart for selecting surgical airways in neurologically impaired pediatric patients (NIPPs).
Main Methods:
- A flowchart was created incorporating patient background, intubation duration, prognosis, and aspiration history.
- Surveys assessed pediatrician perspectives on surgical airway selection and flowchart appropriateness among pediatricians and caregivers.
Main Results:
- 21 NIPPs underwent surgery; 24 participants (14 pediatricians, 10 caregivers) completed surveys.
- Pediatricians reported frequent difficult decisions in surgical airway selection.
- All participants expressed satisfaction with the decision-making process and postoperative outcomes using the flowchart.
Conclusions:
- The developed flowchart is effective for selecting appropriate surgical airways in NIPPs.
- Utilizing the flowchart enhances satisfaction with decision-making and postoperative care for pediatricians and caregivers.
Objective:
Medical advances have resulted in increased survival rates of neurologically impaired children who may require mechanical ventilation and subsequent tracheostomy as a surgical airway. However, at present, there is no definite consensus regarding the timing and methods for placement of a surgical airway in a neurologically impaired intubated child who needs to be cared for over a long-term period. We therefore created a flowchart for the selection of a surgical airway for Neurologically Impaired Pediatric Patients (NIPPs).
Methods:
The flowchart includes information on the patients' backgrounds, such as intubation period, prognosis related to reversibility, and history of aspiration pneumonia. To evaluate the importance of the flowchart, first we conducted a survey of pediatricians regarding selection of a surgical airway, and we also evaluated the appropriateness of the flowchart among pediatricians and caregivers through questionnaire surveys which include satisfaction with the decision-making process, and postoperative course after discharge.
Results:
A total of 21 NIPPs with intubation underwent surgery and a total of 24 participants (14 pediatricians and 10 caregivers) completed the survey. The answers regarding the importance of the flowchart showed that eleven pediatricians had experience selecting of surgical airways, nine of whom had had experiences in which they had to make a difficult decision. The answers regarding the appropriateness of the flowchart revealed that all pediatricians and caregivers were satisfied with the decision-making process and postoperative course after discharge using the flowchart.
Conclusions:
The present study demonstrated the effectiveness of our flowchart for selecting an appropriate surgical airway in NIPP. By referring to our flowchart, pediatricians and caregivers are likely to be able to select an appropriate surgical airway, leading to increased satisfaction with the decision-making process and postoperative course.
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