Related Experiment Videos
Complications of airway intrusion in 100 consecutive cases in a pediatric ICU
Insights
Complications from pediatric airway interventions like orotracheal intubation, nasotracheal intubation, and tracheostomy were assessed. Tracheostomy posed the highest risk, with seizures and infections increasing complication rates.
Area of Science:
- Pediatric Critical Care Medicine
- Airway Management
- Intensive Care Unit (ICU) Procedures
Background:
- Airway interventions are critical in pediatric intensive care but carry inherent risks.
- Understanding complication rates associated with different airway invasive procedures is essential for patient safety.
- Previous studies have highlighted potential adverse events, necessitating further investigation in a pediatric cohort.
Purpose of the Study:
- To evaluate the incidence and types of complications associated with orotracheal intubation, nasotracheal intubation, and tracheostomy in pediatric ICU patients.
- To identify risk factors and patient conditions associated with major complications from airway interventions.
- To compare complication rates among the different airway invasive procedures.
Main Methods:
- A prospective evaluation of 100 consecutive pediatric ICU patients undergoing orotracheal intubation, nasotracheal intubation, or tracheostomy.
- Systematic documentation of major complications related to airway interventions.
- Analysis of patient diagnoses, co-morbidities (seizures, shock), and associated infections.
Main Results:
- Twelve patients experienced major complications from airway interventions.
- Mortality was 17% for mechanically ventilated patients versus 8.3% overall ICU mortality.
- Major complication rates were 10% for orotracheal intubation, 11% for nasotracheal intubation, and 26% for tracheostomy.
- Laryngotracheobronchitis (croup), seizures, hypoperfusion (shock), and specific respiratory infections (Hemophilus influenzae, Pseudomonas, Klebsiella, Candida albicans) were associated with higher complication rates.
Conclusions:
- Tracheostomy is associated with a significantly higher rate of major complications compared to orotracheal and nasotracheal intubation in pediatric ICU patients.
- Patient factors such as seizures, shock, and acquired respiratory infections increase the risk of complications following airway interventions.
- Close monitoring and management of underlying conditions and potential infections are crucial to minimize adverse outcomes in pediatric patients requiring airway invasive procedures.
Abstract:
One-hundred consecutive patients who underwent orotracheal intubation (OT), nasotracheal intubation (NT), or tracheostomy in the pediatric ICU were evaluated for complications of these airway invasions. Twelve patients had major complications as a result of airway intervention. The mortality for patients requiring mechanical ventilation was 17% as compared with a total overall mortality of 8.3% for patients in the pediatric ICU. Major complications occurred in 10% of patients who had orotracheal intubation, in 11% of patients who had nasotracheal intubations, and in 26% of patients subjected to tracheostomy. Laryngotracheobronchitis (croup) was the primary diagnosis associated with the highest rate of complications. An association was found between the occurrence of seizures or hypoperfusion state (shock) while intubated and the occurrence of major complications of airway intrusion. Acquired infections of the respiratory tract with Hemophilus influenzae, Pseudomonas, Klebsiella, and Candida albicans were also associated with a high rate of complications.