Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6464
Peer-review started: December 2, 2021
First decision: January 22, 2022
Revised: February 6, 2022
Accepted: May 7, 2022
Article in press: May 7, 2022
Published online: July 6, 2022
Flexible bronchoscopy (FB) has become a progressively popular diagnostic method for airway evaluation in children, which is advantageous in airway safety when it is used to guide tracheobronchial intubation (TI). Pierre Robin sequence (PRS) is a congenital disability in humans, and difficult intubation has been reported in 71% of children with PRS before surgery. Previous studies have indicated that endotracheal intubation using FB is safe and effective even in neonates with PRS. However, it is a new challenge to perform TI using FB for nurses who lack experience. Some research investigated the incidence and severity of complications of TI using FB in adults, but children have not been investigated.
The incidence and severity of complications of TI using FB in children remain to be investigated.
This study aimed to analyze demographic characteristics, success rates of intubation, the time required for intubation, number of intubation attempts, and postoperative complications of children with PRS and those with common pneumonia who did not have a difficult airway.
105 children with PRS from the Department of Stomatology, and 108 children with common pneumonia from the Department of Respiratory Medicine, at Children’s Hospital in Guangzhou, China, from January 2016 to January 2019 were recruited. The procedures were performed in the bronchoscopy room of the respiratory department. The data were collected from the perioperative records and other electronic medical records according to the survey items. The demographic data, success rates of intubation, the time required for intubation, number of intubation attempts, and the incidence of perioperative complications in the two groups were assessed. Furthermore, the attempts of intubation were also recorded. The possible complications were observed.
There was no significant difference in age and gender between the two groups; however, the weight difference between the two groups was significant. There were no deaths during the perioperative period. The success rate of intubation was 100% for the children in the two groups, while the success rate at the first attempt of children in the PRS group was significantly lower than that in the control group (88.6% vs 98.2%, P = 0.005). The time required for intubation in the PRS group was significantly longer than that in the control group (P < 0.001), and children in the PRS group needed more attempts of intubation than those in the control group to enter the glottis successfully (P = 0.017). The incidence of complications was markedly higher in the PRS group (50/105, 47.6%) than in the control group (36/108, 33.3%) (P = 0.034). Seven of 105 PRS children experienced LE (6.7%), compared with one (0.9%) in the control group. The rate of LE differed markedly between the groups (P = 0.034). Out of the seven patients who had LE, the mean age was 1.19 ± 0.82 months, the mean weight was 3.33 ± 0.75 kg, the time required for intubation was 65 58–68 s, and there were two or three reintubation attempts for bronchoscopy and endotracheal intubation. All seven patients were managed with steroids: six recovered with inhaled steroids alone before extubation, and one was given systemic corticosteroids before recovery. There was no significant difference (P > 0.05) in other complications between the PRS group and control group.
Given the high success rate of intubation using FB for children with PRS, it is a promising alternative for the management of difficult tracheal intubation. The incidence of postoperative complications of TI using FB, especially LE, is higher in children with PRS compared to children with pneumonia.
Effective care measures for the complications of TI using FB in children with PRS will be further explored, and the prevention of LE remains to be improved in the future.