Nursing Management of Acute Airway Hyperresponsiveness and Stenosis in a Pediatric Patient Undergoing Adjustable...

Area of Science:

• Pediatric surgery
• Anesthesiology
• Critical care nursing

Background:

• Pediatric adjustable spinal device surgery, though generally safe, carries risks of severe perioperative airway complications.
• Acute airway hyperresponsiveness and extrinsic tracheal stenosis are rare but life-threatening complications.

Purpose of the Study:

• To report the first documented case of a child experiencing acute airway hyperresponsiveness and severe extrinsic tracheal stenosis post-spinal rod adjustment.
• To describe a successful multidisciplinary nursing management strategy for this complex dual pathology.

Main Methods:

• Adherence to CARE guidelines for case reporting.
• Implementation of a multidisciplinary nursing strategy including protocolized bronchospasm management, early stenosis recognition via imaging, VAP prevention, safe transfer planning, and supportive care.
• Utilized deep sedation, bronchodilators, and 3D imaging for surveillance.

Main Results:

• Successful stabilization of the pediatric patient's airway, maintaining oxygen saturation >95%.
• Reduced peak inspiratory pressure and prevented ventilator-associated pneumonia.
• Healed pressure injury, resolved delirium and seizures, leading to discharge on day 9.

Conclusions:

• Proactive airway surveillance, particularly with advanced imaging, is crucial in high-risk pediatric spinal surgeries.
• Integrated, evidence-based nursing protocols within a multidisciplinary framework are vital for managing complex perioperative airway complications.