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Intensive Care Unit Admission Following Cleft Palate Repair in Patients With Pierre Robin Sequence Corrected With
Shelby D Goza1, Katherine E Baker1, Madyson I Brown1
1University of Mississippi Medical Center, Division of Plastic and Reconstructive Surgery, Jackson, Mississippi.
Insights
Pediatric patients with Pierre Robin Sequence (PRS) who underwent mandibular distraction (MD) and cleft palate (CP) repair generally do not require pediatric intensive care unit (PICU) admission, indicating floor care is often safe post-surgery.
Area of Science:
- Craniofacial surgery
- Pediatric surgery
- Airway management
Background:
- Pierre Robin Sequence (PRS) patients often have cleft palate (CP) and undergo mandibular distraction (MD).
- Standardized protocols for pediatric intensive care unit (PICU) admission post-CP repair in these patients are lacking.
- This study evaluates airway events after CP repair in PRS patients with prior MD.
Purpose of the Study:
- To determine the frequency of airway events following cleft palate repair in patients with Pierre Robin Sequence who have undergone mandibular distraction.
- To assess the safety and necessity of pediatric intensive care unit admission after cleft palate repair in this specific patient population.
Main Methods:
- Retrospective chart review of PRS patients (2012-2022) who had both MD and CP repair.
- Data collected included: analgesic use, respiratory status, comorbidities, and operative details.
- Primary outcomes: length of stay, airway events, and PICU admission post-CP repair.
Main Results:
- Out of 13 patients who underwent CP repair post-MD, only 2 experienced airway events.
- Just 3 patients required PICU admission; comorbidities were associated with PICU need.
- Longer intubation post-MD correlated with PICU admission and prolonged post-CP repair intubation.
Conclusions:
- CP repair in PRS patients with a history of MD appears safe for floor admission.
- Comorbidities and prolonged intubation are key factors influencing PICU admission decisions.
Background:
Patients with Pierre Robin Sequence (PRS) treated with mandibular distraction (MD) frequently suffer from a cleft palate (CP). There are no standard practices surrounding the need for admission to a pediatric intensive care unit (PICU) following CP repair in these patients. This study will investigate the frequency of airway events following CP repair in this subset of patients.
Methods:
A retrospective chart review of all patients with PRS treated with MD that also required CP repair surgery at the authors' institution from 2012 to 2022 was performed. Intraoperative and postoperative analgesic usage, preoperative and postoperative respiratory status, presence of a concomitant operation, comorbid anomalies, as well as age and weight at CP repair were recorded. Our primary outcomes included length of stay following CP repair, presence of airway events perioperatively/postoperatively, and admission status following CP repair.
Results:
Twenty-nine patients underwent MD during this period, of which 13 patients also underwent repair of a CP. The average length of stay following CP repair was 2.3 days. Only 2 airway events were noted, and only 3 patients were admitted to the PICU following repair. Presence of comorbid musculoskeletal and neurologic abnormalities was associated with postoperative PICU admission.Remaining intubated following CP repair was associated with increased analgesic usage intraoperatively. A longer duration of intubation following MD was associated with PICU admission and remaining intubated following CP repair.
Conclusions:
Overall, it appears that admission to the floor following CP repair in PRS patients with a history of MD is generally safe.
