RESUMO
OBJECTIVES/HYPOTHESIS: The anatomy of children with severe Pierre Robin sequence can present a challenge for direct laryngoscopy and intubation. Advanced techniques including flexible fiberoptic laryngoscopic intubation have been described but require highly specialized skill and equipment. Rigid video laryngoscopy is more accessible but has not been described in this population. STUDY DESIGN: Retrospective cohort study. METHODS: A retrospective review was completed at a tertiary care center of all children between January 2016 and March 2020 with Pierre Robin sequence who underwent a mandibular distraction osteogenesis procedure. Intubation events were collected, and a descriptive analysis was performed. A univariate logistic regression model was applied to direct laryngoscopy and flexible fiberoptic laryngoscopy with rigid video laryngoscopy as a reference. RESULTS: Twenty-five patients were identified with a total of 56 endotracheal events. All patients were successfully intubated. Direct laryngoscopy was successful at first intubation attempt in 47.3% (9/19) of events. Six direct laryngoscopy events required switching to another device. Rigid video laryngoscopy was successful at first intubation attempt in 80.5% (29/36) of events. Two cases required switching to another device. Flexible fiberoptic laryngoscopy was found successful at first intubation attempt in 88.9% (8/9) of events. Direct laryngoscopy was 4 times more likely to fail first intubation attempt when compared to rigid video laryngoscopy (P < .05). There was no significant difference between rigid video laryngoscopy and flexible fiberoptic laryngoscopy for intubation. CONCLUSIONS: For children with Pierre Robin sequence rigid video laryngoscopy should be considered as a first attempt intubation device both in the operating room and for emergent situations. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1647-1651, 2021.
Assuntos
Obstrução das Vias Respiratórias/cirurgia , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Síndrome de Pierre Robin/complicações , Adolescente , Obstrução das Vias Respiratórias/etiologia , Criança , Pré-Escolar , Falha de Equipamento , Feminino , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal/instrumentação , Laringoscópios , Laringoscopia/instrumentação , Masculino , Mandíbula/anormalidades , Mandíbula/cirurgia , Osteogênese por Distração , Síndrome de Pierre Robin/diagnóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
OBJECTIVE: To determine the prevalence and impact of adverse effects of medical care in patients who underwent excision of cervical lymph nodes. STUDY DESIGN: Data from the Nationwide Inpatient Sample for the years 2009 and 2010 were used. The outcome variables were complications. The independent variables were occurrence of adverse effects of medical care and adverse effects of drugs/medication used in therapeutic use during hospitalization. RESULTS: A total of 48,413 hospitalizations involved excision of cervical lymph nodes. The mean age was 59 years. Males constituted 64.2% of hospitalizations. Adverse effects of medical care occurred in 9.5% of hospitalizations, and adverse effects due to therapeutic use of medications occurred in 1.8%. Frequently occurring complications included postoperative pneumonia (4.2%), hemorrhagic complications (3.5%), other infections (1.7%), cardiac complications (1.5%), bacterial infections (1.5%), respiratory complications (1.4%), nonhealing wounds (1.3%), septicemia (1.2%), and mycoses (1.2%). CONCLUSIONS: Occurrence of adverse effects of medical care was associated with high odds for multiple complications.