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1
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Chellen S, Mulla S. Term neonate with neck and supraclavicular swelling at birth. Arch Dis Child Educ Pract Ed 2024; 109:201-208. [PMID: 38844076 DOI: 10.1136/archdischild-2022-325142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/28/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Shavindra Chellen
- Neonatal Unit, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Shaveta Mulla
- Neonatal Unit, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
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2
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Serio P, Fainardi V, Coletta R, Grasso A, Baggi R, Rufini P, Avenali S, Ricci Z, Morabito A, Trabalzini F. Conservative management of posterior tracheal wall injury by endoscopic stent placement in children: Preliminary data of three cases. Int J Pediatr Otorhinolaryngol 2022; 159:111214. [PMID: 35759914 DOI: 10.1016/j.ijporl.2022.111214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/17/2022] [Accepted: 06/18/2022] [Indexed: 11/26/2022]
Abstract
The management of tracheal wall lacerations is debated. Current treatments are mainly derived by the experience on adults and include conservative or surgical treatments depending on the clinical condition of the patient. We report our preliminary data with removable tracheal stents in 3 children with tracheal tears and respiratory failure. If performed in specialized centers with appropriate endoscopic and clinical follow-up, airway stents can be considered a valid and safe conservative treatment for tracheal tears and an alternative to intubation or tracheostomy. Further studies are needed to compare different therapeutic options and better define the management and duration of stent treatment.
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Affiliation(s)
- P Serio
- Department of Paediatric Anaesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy.
| | - V Fainardi
- Department of Medicine and Surgery, Cystic Fibrosis Unit, University of Parma, Italy
| | - R Coletta
- Department of Paediatric Surgery, Meyer Children Hospital, University of Florence, Florence, Italy
| | - A Grasso
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - R Baggi
- Respiratory Endoscopy Unit, Meyer Children Hospital, Florence, Italy
| | - P Rufini
- Department of Paediatric Anaesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy
| | - S Avenali
- Respiratory Endoscopy Unit, Meyer Children Hospital, Florence, Italy
| | - Z Ricci
- Department of Paediatric Anaesthesia and Intensive Care, Meyer Children Hospital, Florence, Italy
| | - A Morabito
- Department of Paediatric Surgery, Meyer Children Hospital, University of Florence, Florence, Italy
| | - F Trabalzini
- Department of Otolaryngology, Meyer Children Hospital, Florence, Italy
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3
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Li KX, Luo YT, Zhou L, Huang JP, Liang P. Tracheal tube misplacement in the thoracic cavity: A case report. World J Clin Cases 2021; 9:10733-10737. [PMID: 35005009 PMCID: PMC8686131 DOI: 10.12998/wjcc.v9.i34.10733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/09/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Penetrating neck injuries require prompt recognition, diagnosis and management of critical airways. This case demonstrates an emergent situation that a "medical negligence" was avoided with the aid of end-tidal carbon dioxide (ETCO2) waveform. CASE SUMMARY We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma, resulting in pneumothorax. Tube placement was not confirmed during emergency airway management, and the patient was directly transferred to the emergency operation room. Assisted by ETCO2 and imaging examinations, the anesthetist timely noticed the absence of ETCO2 waveform and resolved this urgent situation before anesthesia induction. CONCLUSION This case emphasizes the necessity of ETCO2 waveform and/or X-ray confirmation of endotracheal intubation even in emergent situations.
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Affiliation(s)
- Ke-Xin Li
- Department of Anesthesiology, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Yu-Ting Luo
- Department of Anesthesiology, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Leng Zhou
- Department of Anesthesiology, West China Hospital, Chengdu 610041, Sichuan Province, China
| | - Jia-Peng Huang
- Department of Anesthesiology, University of Louisville, Louisville, KY 40202, United States
| | - Peng Liang
- Day Surgery Center, Department of Anesthesiology, West China Hospital, Chengdu 610041, Sichuan Province, China
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4
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Altamimi T, Read B, da Silva O, Bhattacharya S. Airway injury and pneumomediastinum associated with less invasive surfactant administration in a premature neonate: a case report. BMC Pediatr 2021; 21:500. [PMID: 34758781 PMCID: PMC8579620 DOI: 10.1186/s12887-021-02981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background The use of less invasive surfactant administration (LISA)/minimally invasive surfactant therapy (MIST) has increased due to its potential advantage over traditional surfactant delivery methods through an endotracheal tube. Known complications for this procedure include failure of the first attempt at insertion, desaturation, and bradycardia. To the best of our knowledge, this is the first reported case of pneumomediastinum and subcutaneous emphysema following LISA. Case presentation A preterm newborn born at 27 weeks of gestation presented with respiratory distress syndrome requiring surfactant replacement. LISA using the Hobart method was completed. There was a report of procedural difficulty related to increased resistance to insertion of the 16G angiocath. The newborn was subsequently noted to have subcutaneous emphysema over the anterior aspect of the neck and substantial pneumomediastinum on radiological assessment. Associated complications included hypotension requiring inotropic support. The newborn was successfully managed conservatively, with complete resolution of the air leak. Conclusions Upper airway injury leading to air leak syndrome is a rare complication of the Hobart method for LISA. Awareness of such procedural complications is important as the use of the LISA method increases.
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Affiliation(s)
- Talal Altamimi
- Neonatal - Perinatal Medicine, University of Western, 800 Commissioners Rd E, D4-200, London, Ontario, N6A 5W9, Canada.
| | - Brooke Read
- Neonatal - Perinatal Medicine, University of Western, 800 Commissioners Rd E, D4-200, London, Ontario, N6A 5W9, Canada
| | - Orlando da Silva
- Neonatal - Perinatal Medicine, University of Western, 800 Commissioners Rd E, D4-200, London, Ontario, N6A 5W9, Canada
| | - Soume Bhattacharya
- Neonatal - Perinatal Medicine, University of Western, 800 Commissioners Rd E, D4-200, London, Ontario, N6A 5W9, Canada
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5
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Taylor A, Menon S, Grant P, Currie B, Soma M. Traumatic Pediatric Tracheal Rupture After Blunt Force Sporting Injury: Case Report and Review of the Literature. Ann Otol Rhinol Laryngol 2021; 131:923-927. [PMID: 34541893 DOI: 10.1177/00034894211046707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This paper presents the case of a traumatic tracheal rupture in a pediatric patient. The body of literature of the clinical features, evaluation, and management of this uncommon presentation is discussed. CASE A 13-year-old boy sustained an intrathoracic tracheal rupture whilst playing Australian Rules football. He developed hallmark clinical features of air extravasation and was intubated prior to transfer to a tertiary pediatric center for further management. After a short trial of conservative management, his respiratory status deteriorated and he was taken to the operating theater for open surgical repair of the defect. CONCLUSION Traumatic rupture of the trachea is a rare injury in children. This case demonstrates the dynamic nature of this serious injury and the need for multidisciplinary care in achieving the optimal outcome.
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Affiliation(s)
- Alon Taylor
- Department of Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Seema Menon
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Peter Grant
- Department of Cardiothoracic Surgery, Sydney Children's Hospital, Randwick, NSW, Australia.,Department of Cardiothoracic Surgery, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Bruce Currie
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Marlene Soma
- Department of Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
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6
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Carratola M, Hart CK. Pediatric tracheal trauma. Semin Pediatr Surg 2021; 30:151057. [PMID: 34172217 DOI: 10.1016/j.sempedsurg.2021.151057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Tracheal trauma is an uncommon but potentially serious cause of airway injury in children. Presentation may be acute in cases of blunt or penetrating trauma, or delayed in cases of chronic irritation or indwelling endotracheal tubes. Symptoms include dyspnea, progressive respiratory distress, neck and chest swelling and ecchymosis, and dysphonia. Workup is pursued as allowed by the patient's clinical status and may include plain radiography, computed tomography, and endoscopy. Accuracy and efficiency of diagnosis is paramount for those at risk of rapid decompensation. Treatment may include observation, elective and strategic intubation, or primary surgical repair.
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Affiliation(s)
- Maria Carratola
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA.
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Pamukcu U, Dal A, Altuntas N, Cınar C, Altunkaynak B, Peker I. Knowledge, behavior, and awareness of neonatologists and anesthesiologists about oral complications of intubation and protection methods. Int Dent J 2020; 70:374-380. [PMID: 32368806 DOI: 10.1111/idj.12572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES This study aimed to assess awareness of anesthesiologists and neonatologists about oral complications occurring during and after the orotracheal intubation (OTI) in premature infants and their knowledge and behavior regarding protection methods from these complications in clinical practice. METHODS This study included 94 neonatologists and 137 anesthesiologist. The final version of the questionnaire included 15 items in three main parts: (i) personal information; (ii) awareness about oral complications occurring during and after the OTI in premature infants; (iii) knowledge and behavior regarding protection methods from these complications in clinical practice. RESULTS A total of 95.7% of neonatologists and 83.2% of anesthesiologists were aware of oral complications related to OTI. The most common complications the anesthesiologists encountered were oral, laryngeal, or pharyngeal region injuries (60.7%) and palatal groove (52.2%) for the neonatologists. The most preferred method for stabilization of the orotracheal intubation tube (OTT) was bonding to the perioral region with an adhesive tape (98.3%). The primary determining factor in the choice of OTT stabilization method was the ease of use (28.2%). A total of 23.8% of the participants were aware of the palatal stabilization device (PSD), whereas only 1.3% used it in their routine and 57.1% of them believed it can prevent complications. CONCLUSIONS The results showed that neonatologists were more aware of the OTI-related oral complications than anesthesiologists. The knowledge of the participants regarding prevention of these complications is insufficient. Study participants believe in the efficacy of PSD but do not use it in clinical practice for a number of reasons.
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Affiliation(s)
- Umut Pamukcu
- Department of Dentomaxillofacial Radiology, Gazi University Faculty of Dentistry, Ankara, Turkey
| | - Aycan Dal
- Department of Pedodontics, Gazi University Faculty of Dentistry, Ankara, Turkey
| | - Nilgun Altuntas
- Newborn Department, Ankara Yıldırım Beyazıt University Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Cagdas Cınar
- Department of Pedodontics, Gazi University Faculty of Dentistry, Ankara, Turkey
| | - Bulent Altunkaynak
- Department of Statistics, Faculty of Sciences, Gazi University, Ankara, Turkey
| | - Ilkay Peker
- Department of Dentomaxillofacial Radiology, Gazi University Faculty of Dentistry, Ankara, Turkey
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Doctor TN, Foster JP, Stewart A, Tan K, Todd DA, McGrory L. Heated and humidified inspired gas through heated humidifiers in comparison to non-heated and non-humidified gas in hospitalised neonates receiving respiratory support. Hippokratia 2017. [DOI: 10.1002/14651858.cd012549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tejas N Doctor
- Monash Medical Centre; Monash Newborn; 246 Clayton Road Clayton Victoria Australia 3168
| | - Jann P Foster
- Western Sydney University; School of Nursing and Midwifery; Penrith DC Australia
- University of Sydney; Sydney Nursing School/Central Clinical School, Discipline of Obstetrics, Gynaecology and Neonatology; Sydney Australia
- Ingham Research Institute; Liverpool NSW Australia
| | - Alice Stewart
- Monash Medical Centre; Monash Newborn; 246 Clayton Road Clayton Victoria Australia 3168
| | - Kenneth Tan
- Monash University; Department of Paediatrics; 246 Clayton Road Clayton Melbourne Victoria Australia VIC 3168
| | - David A Todd
- The Canberra Hospital; Neonatal Unit; Centre for Newborn Care PO Box 11, Woden Canberra ACT Australia 2606
| | - Lorraine McGrory
- The Royal Women's Hospital; Neonatal Services; Parkville Victoria Australia
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9
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Lee SK, Chang DJ, Park EY, Lim T, Kim KM, Jang SW, Joo S. Perioperative management of tracheal injury following endotracheal intubation in a neonate −A case report−. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.1.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Soo Kyung Lee
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Dong Jin Chang
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Eun Young Park
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Taewan Lim
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Kyung Mi Kim
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Sung Wook Jang
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Sungmin Joo
- Department of Anesthesiology and Pain Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
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Kelley R, Reynders A, Seidberg N. Nonsurgical Management of Pediatric Tracheal Perforation. Ann Otol Rhinol Laryngol 2016; 115:408-11. [PMID: 16805370 DOI: 10.1177/000348940611500602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tracheal perforation is a rare complication of intubation. In the pediatric population, the rates of morbidity and mortality are high if diagnosis and management are delayed. Recommendations for treatment in these patients are based on the several reports of this injury in the adult and neonate populations. Surgical repair is generally favored over conservative care in the majority of cases. We describe the case of a 10-year-old girl who presented with subcutaneous emphysema after intubation in the emergency department. The patient had a 3-cm injury to the distal trachea. Nonsurgical management resulted in a normal-appearing trachea and a healed perforation site as confirmed by repeat tracheobronchoscopy 4 months after the initial injury. In clinically stable pediatric patients, nonsurgical management of tracheal perforations should be considered.
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Affiliation(s)
- Richard Kelley
- Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, New York 13210, USA
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11
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Neonatal Resuscitation Training: Implications of Course Construct and Discipline Compartmentalization on Role Confusion and Role Ambiguity. Adv Neonatal Care 2016; 16:201-10. [PMID: 27140032 DOI: 10.1097/anc.0000000000000294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Neonatal Resuscitation Program's (NRP's) Sixth Edition introduced simulation-based training (SBT) into neonatal life support training. SBT offers neonatal emergency response teams a safe, secure environment to rehearse coordinated neonatal resuscitations. Teamwork and communication training can reduce tension and anxiety during neonatal medical emergencies. PURPOSE To discuss the implications of variability in number and type of simulation scenario, number and type of learners who comprise a course, and their influence upon scope of practice, role confusion, and role ambiguity. METHODS Relevant articles from MEDLINE, CINAHL, EMBASE, Google Scholar, the World Health Organization, the American Heart Association, and NRP were included in this integrative review of the literature. FINDINGS/RESULTS Purposeful synergy of optimal SBT course construct with teamwork and communication can resist discipline compartmentalization, role confusion, and role ambiguity. Five key themes were identified and coined the "5 Rights" of NRP SBT. These "5 Rights" can guide healthcare institutions with planning, implementation, and evaluation of NRP SBT courses. IMPLICATIONS FOR PRACTICE NRP SBT can facilitate optimal team function and reduce errors when teams of learners and varied scenarios are woven into the course construct. The simulated environment must be realistic and fully equipped to encourage knowledge transfer and attainment of the NRP's key behavioral outcomes. IMPLICATIONS FOR RESEARCH Investigation of teamwork and communication training with NRP SBT, course construct, discipline compartmentalization, and behavioral and clinical outcomes is indicated. Investigation of outcomes of SBT using a team-teaching model, combining basic and advanced practice NRP instructors, is indicated.
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12
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Abstract
BACKGROUND To record and analyze critical incidents is of paramount importance for any organization dedicated to improving patient safety. Therefore, many hospitals have implemented a critical incident reporting system (CIRS). However, the impact, benefits and use of such CIRS systems on patient safety have often been reported to be unsatisfactory. AIM What have we learned over the past decade about the effective and optimal use of a CIRS? MATERIAL AND METHODS Following the Yorkshire contributory factors framework, the potential benefits of a CIRS are illustrated with selected examples from the neonatal and pediatric intensive care unit. Based on a literature search in PubMed from January 2000 to December 2014 this article also describes critical factors and concepts for the successful use of a CIRS. RESULTS A positive mind-set towards errors, high psychological safety and the conviction that a CIRS can be beneficial are important factors to encourage individual healthcare personnel to report critical incidents and learn from errors. On the part of the organization, adequate resources of personnel, systematic analysis of the reported incidents as well as dissemination of the results and implementation of safety improvement strategies are critical factors for the effective use of a CIRS. All incidents with potential relevance for patient safety should be reported. The categorization of the reported incidents facilitates the analysis and identification of relevant conclusions. As an organization dedicated to improve patient safety we have to learn from errors as well as from successes. CONCLUSION The successful use of a CIRS depends on the motivation of individual healthcare providers as well as on organizational features that encourage critical incident reporting.
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Wood JW, Thornton B, Brown CS, McLevy JD, Thompson JW. Traumatic tracheal injury in children: a case series supporting conservative management. Int J Pediatr Otorhinolaryngol 2015; 79:716-20. [PMID: 25792031 DOI: 10.1016/j.ijporl.2015.02.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Injuries to the tracheobronchial region are rare, but have the potential for rapid progression and can become life-threatening. Etiologies of non-penetrating tracheobronchial injuries include blunt cervical trauma, endotracheal intubation, and other iatrogenic causes. Several options for treatment ranging from conservative to surgical exist, but no single treatment has been implemented with consensus. While early surgical repair was once considered the cornerstone of therapy, evidence supporting conservative treatment continues to gain strength. METHODS All pediatric patients who suffered from non-penetrating injuries to the tracheobronchial tree who were treated by the Otolaryngology Service at a tertiary children's hospital from May 2012 through March 2014 were recorded. A total of 8 patients were identified. The cases were collected from the patients treated by the Otolaryngology Department based on retrospective review. The available electronic medical records were reviewed for each patient. Data including type of injury, endoscopic assessment of injury, treatment received, and follow-up were collected. RESULTS The ages ranged from 2 to 15 years old, with a mean of 9.25 years old. Six of the eight patients had injuries related to endotracheal intubation. Each patient was taken to the operating suite for diagnostic direct laryngoscopy and bronchoscopy, and treated with initial conservative management. All but one of the patients was treated with endotracheal intubation, and the average length of intubation was 11.71 days. All of the injuries healed spontaneously without requiring initial open surgery. Five patients (62.5%) developed some degree of tracheal stenosis. Three patients (37.5%) required further surgery; one received a tracheostomy and two patients required balloon dilation. CONCLUSIONS This case series is the largest to date documenting the outcomes of conservative treatment of non-penetrating traumatic tracheal injuries in children. By using initial conservative therapy, we were able to avoid open surgical procedures in many of our patients. We believe that this case series provides further support for conservative management for children with tracheobronchial injuries.
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Affiliation(s)
- Joshua W Wood
- University of Tennessee Health Science Center, Department of Otolaryngology-Head & Neck Surgery, Memphis, TN, United States.
| | - Blakely Thornton
- University of Tennessee Health Science Center, Department of Otolaryngology-Head & Neck Surgery, Memphis, TN, United States
| | - C Scott Brown
- University of Tennessee Health Science Center, Department of Otolaryngology-Head & Neck Surgery, Memphis, TN, United States
| | - Jennifer D McLevy
- University of Tennessee Health Science Center, Department of Otolaryngology-Head & Neck Surgery, Memphis, TN, United States
| | - Jerome W Thompson
- University of Tennessee Health Science Center, Department of Otolaryngology-Head & Neck Surgery, Memphis, TN, United States
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14
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Luks V, Moores C, Villalona G, Stitelman DH, Caty MG. Successful non-operative management of a contained tracheal tear following iatrogenic endotracheal tube injury. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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15
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Siegel B, Bent JP, Weinstein S. Tracheal rupture in complicated delivery: a case report and review of the literature. Int J Pediatr Otorhinolaryngol 2014; 78:1784-8. [PMID: 25130942 DOI: 10.1016/j.ijporl.2014.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/16/2014] [Accepted: 07/20/2014] [Indexed: 01/30/2023]
Abstract
A case of distal tracheal rupture is described, literature review reveals two previously reported cases of neonatal distal tracheal rupture, as well as 14 cases of anterior subglottic rupture. All patients had shoulder dystocia, and 59% had associated brachial plexus injury. Delayed diagnosis (>3 days) was common in the distal tracheal group (66%), compared to 0% in the anterior subglottic group. The 2 distal tracheal rupture patients were initially managed conservatively, but ultimately required open repair. Distal tracheal rupture is exceedingly rare and more difficult to diagnose and manage than the more common anterior subglottic rupture.
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Affiliation(s)
- Bianca Siegel
- Albert Einstein College of Medicine, Bronx, NY, United States; Montefiore Medical Center, Bronx, NY, United States; Childrens Hospital at Montefiore, Bronx, NY, United States.
| | - John P Bent
- Albert Einstein College of Medicine, Bronx, NY, United States; Montefiore Medical Center, Bronx, NY, United States; Childrens Hospital at Montefiore, Bronx, NY, United States
| | - Samuel Weinstein
- Albert Einstein College of Medicine, Bronx, NY, United States; Montefiore Medical Center, Bronx, NY, United States; Childrens Hospital at Montefiore, Bronx, NY, United States
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Airway management in a patient with blunt trauma neck: A concern for anesthesiologist. EGYPTIAN JOURNAL OF ANAESTHESIA 2014. [DOI: 10.1016/j.egja.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Xu X, Xing N, Chang Y, Du Y, Li Z, Wang Z, Yan J, Zhang W. Tracheal rupture related to endotracheal intubation after thyroid surgery: a case report and systematic review. Int Wound J 2014; 13:268-71. [PMID: 24871935 DOI: 10.1111/iwj.12291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 03/31/2014] [Indexed: 11/28/2022] Open
Abstract
Tracheobronchial rupture is an uncommon but potentially serious complication of endotracheal intubation. The most likely cause of tracheal injury is massive overinflation of the endotracheal tube cuff and pre-existing tracheal wall weakness. We review the relevant literature and predisposing factors contributing to this complication. Only articles that reported at least the demographic data (age and sex), the treatment performed and the outcome were included. Papers that did not detail these variables were excluded. We also focus on a case of tracheal laceration after tracheal intubation in a patient with severe thyroid carcinoma. This patient received surgical repair and recovered uneventfully. Two hundred and eight studies that reported cases or case series were selected for analysis. Most of the reported cases (57·2%) showed an uneventful recovery after surgical therapy. The overall mortality was 19·2% (40 patients). Our patient too recovered without any serious complication. Careful prevention, early detection and proper treatment of the problem are necessary when tracheal rupture occurs. The morbidity and mortality associated with tracheal injury mandate a high level of suspicion and expedient management.
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Affiliation(s)
- Xiaohan Xu
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Na Xing
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yanzi Chang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yingying Du
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Zhisong Li
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Zhongyu Wang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Jie Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Wei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Henan, China
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Restaino KM, Obermeyer RJ, Tsai FW. Surgical repair of an iatrogenic tracheal injury in a very low birth weight infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lagoo JY, Jose J, Kilpadi KA. Tracheal perforation in a neonate: A devastating complication following traumatic endotracheal intubation. Indian J Anaesth 2014; 57:623-4. [PMID: 24403630 PMCID: PMC3883405 DOI: 10.4103/0019-5049.123343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Jui Y Lagoo
- Department of Anaesthesia, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Jiby Jose
- Department of Anaesthesia, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Kshma A Kilpadi
- Department of Anaesthesia, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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Abstract
Tracheal rupture is rare in childhood, and optimal treatment is not clear. A 14-year-old boy was admitted to a local hospital after sudden loss of consciousness. He underwent endotracheal intubation and was referred to our hospital. The patient's history revealed that he had voluntarily inhaled butane gas. The physical examination was consistent with coma and cardiogenic shock, and the chest radiograph showed pulmonary edema. The patient was admitted to the intensive care unit, and diuretic and inotropic therapy was started. In the third hour of monitoring of the patient under mechanical ventilation, subcutaneous emphysema and pneumothorax at the right hemithorax were observed without deterioration of the vital functions. Thoracic computed tomography scan findings were consistent with tracheal rupture. The patient was monitored conservatively without surgery. On the fifth day of hospitalization, his tube was removed, and he was discharged on the 12th day with a positive prognosis. In this study, a tracheal rupture case after endotracheal intubation is presented in which the patient recovered completely with conservative therapy.
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Kamlin COF, O'Connell LAF, Morley CJ, Dawson JA, Donath SM, O'Donnell CPF, Davis PG. A randomized trial of stylets for intubating newborn infants. Pediatrics 2013; 131:e198-205. [PMID: 23230069 DOI: 10.1542/peds.2012-0802] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Endotracheal intubation of newborn infants is a common and potentially lifesaving procedure but a skill that trainees find difficult. Despite widespread use, no data are available on whether the use of a stylet (introducer) improves success rates. We aimed to determine whether pediatric trainees were more successful at neonatal orotracheal intubation when a stylet was used. METHODS An unblinded randomized controlled trial conducted between July 2006 and January 2009 at a tertiary perinatal center, the Royal Women's Hospital, Melbourne, Australia. Eligible participants were newborn infants in the delivery room or NICU requiring endotracheal intubation for respiratory support. Infants were intubated by pediatric residents or fellows. Infants were randomized to have the procedure performed by using either an endotracheal tube alone or with a stylet. Successful intubation at the first attempt assessed by colorimetric detection of expired carbon dioxide was the primary outcome. RESULTS Three hundred two intubations were performed in 232 infants (residents performed 75%, fellows 25%). Intubation was successful in 57% of the stylet group and 53% of the no stylet group (P = .47); odds ratio 1.18 (95% confidence interval 0.75-1.86). There were no differences in the duration of attempts or in the rate of upper airway trauma between the 2 groups. These results were consistent across subgroups of infants based on birth weight, gestational age, and site of intubation (delivery room or NICU). CONCLUSIONS Using an endotracheal stylet did not significantly improve the success rate of pediatric trainees at neonatal orotracheal intubation.
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Affiliation(s)
- C Omar F Kamlin
- Newborn Services, The Royal Women’s Hospital, Melbourne, Australia.
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22
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Management and prevention of endotracheal intubation injury in neonates. Curr Opin Otolaryngol Head Neck Surg 2011; 19:474-7. [DOI: 10.1097/moo.0b013e32834c7b5c] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hawkins CM, Towbin AJ. Rupture of the left mainstem bronchus following endotracheal intubation in a neonate. Pediatr Radiol 2011; 41:668-70. [PMID: 21076825 DOI: 10.1007/s00247-010-1887-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 10/04/2010] [Accepted: 10/20/2010] [Indexed: 11/29/2022]
Abstract
Tracheobronchial rupture is a rare diagnosis with very high associated mortality in the neonatal population. Our case demonstrates the opportunity to diagnose this entity in a neonate via CT and introduces the utility of virtual bronchoscopy in clinical scenarios that preclude traditional bronchoscopy.
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Affiliation(s)
- C Matthew Hawkins
- Department of Radiology, University Hospital, Cincinnati, OH 45267-0761, USA.
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24
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Hinich E, Jennings RW, Clendenin D. Intermittent single lung ventilation in a 620-gram micropremie during postintubation carinal laceration repair. Paediatr Anaesth 2010; 20:775-7. [PMID: 20670245 DOI: 10.1111/j.1460-9592.2010.03342.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Van Dorn CS, Sittig SE, Koch CA, Thompson DM, Carey WA. Selective fiberoptic left main-stem intubation to treat bronchial laceration in an extremely low birth weight neonate. Int J Pediatr Otorhinolaryngol 2010; 74:707-10. [PMID: 20363034 DOI: 10.1016/j.ijporl.2010.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 03/08/2010] [Indexed: 11/19/2022]
Abstract
A neonate born at 24 weeks gestation developed a right tension pneumothorax that persisted despite the placement of multiple thoracostomy tubes, the use of high-frequency ventilation and postural therapy. On day-of-life 11, bedside bronchoscopy revealed a laceration at the junction of the trachea and right main-stem bronchus. Under fiberoptic guidance the left main-stem bronchus was intubated. Single-lung ventilation then was employed for 24h, after which time the pneumothorax never recurred. We postulate that the diversion of positive-pressure ventilation away from the laceration site allowed the surrounding injury-induced granulation tissue to create a seal and facilitate closure of the defect.
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Affiliation(s)
- Charlotte S Van Dorn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Delgado Pecellín I, González Valencia JP, González Rodríguez M. [Management of postintubation tracheal rupture in pediatric patients]. Arch Bronconeumol 2009; 45:257-8. [PMID: 19376632 DOI: 10.1016/j.arbres.2008.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 08/05/2008] [Accepted: 08/31/2008] [Indexed: 10/20/2022]
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Miller JD, Carlo WA. Pulmonary complications of mechanical ventilation in neonates. Clin Perinatol 2008; 35:273-81, x-xi. [PMID: 18280886 DOI: 10.1016/j.clp.2007.11.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mechanical ventilation is necessary and life saving in many neonates. Most complications are inherent to this intervention and cannot be confused with iatrogenic errors in judgment or care practices by clinicians. Clinical data suggest that complications such as volutrauma and air leak syndromes can negatively affect long-term pulmonary and non-pulmonary outcomes. Careful attention to many aspects of neonatal care, such as delivery room resuscitation, ventilatory support, and routine care practices, is needed to decrease pulmonary complications of mechanical ventilation. Clinical research is needed to improve mechanical ventilator strategies to reduce pulmonary complications and improve long-term outcomes.
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Affiliation(s)
- J Davin Miller
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, 525 New Hillman Building, 619 19th Street South, Birmingham, AL 35233-7335, USA
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Guerra MS, Miranda JA, Caiado A, Almeida J, Moura e Sá J, Leal F, Vouga L. [Iatrogenic tracheal rupture: a case report and indications for conservative management]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2006; 12:71-8. [PMID: 16669134 DOI: 10.1016/s0873-2159(15)30421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Tracheal rupture after endotracheal intubation requires immediate intervention. There have been an increasing number of reports that describe nonsurgical management of this issue. We report the case of a 47-year-old woman who experienced an iatrogenic tracheal rupture during endotracheal intubation for a surgical procedure with general anaesthesia. She was successfully managed conservatively with a broad-spectrum antibiotic. We managed it non-operatively, because the patient had a small tear, was hemodynamically stable, show no evidence of infection or respiratory failure, and the diagnosis was not immediate. Bronchoscopy was a good diagnostic tool and it was used to make decisions regarding conservative management, and to detect granulation tissue and rule out any tracheal stenosis after treatment. We review available literature on conservative management of tracheal rupture. Immediate recognition and adequate treatment are very important in managing this potentially fatal situation. The final decision should be based on clinical, radiologic and bronchoscopic findings.
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Affiliation(s)
- Miguel S Guerra
- Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de Vila Nova de Gaia, Portugal.
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