Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2022; 10(19): 6464-6471
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6464
Tracheobronchial intubation using flexible bronchoscopy in children with Pierre Robin sequence: Nursing considerations for complications
Ying-Long Ye, Cai-Feng Zhang, Li-Zhen Xu, Hui-Feng Fan, Jun-Zheng Peng, Gen Lu, Xiao-Yin Hu
Ying-Long Ye, Cai-Feng Zhang, Li-Zhen Xu, Hui-Feng Fan, Jun-Zheng Peng, Gen Lu, Xiao-Yin Hu, Department of Respiratory Medicine, Guangzhou Women and Children’s Medical Centre, Guangzhou 510623, Guangdong Province, China
Author contributions: Zhang CF, Hu XY and Fan HF studied conception and design; Ye YL, Xu LZ and Peng JZ contributed to data collection; Zhang CF and Lu G contributed to data analysis and interpretation; Ye YL, Zhang CF, and Fan HF contributed to drafting of the article; Hu XY and Fan HF contributed to critical revision of the article; Ye YL and Zhang CF contributed equally to the manuscript.
Institutional review board statement: The protocol was approved by the Medical Ethics Committee of Guangzhou Women and Children’s Medical Centre (approval No.[2020] 24901).
Informed consent statement: All participants, or their legal guardian, signed informed consent before study.
Conflict-of-interest statement: The authors declare that they have no conflict of interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at hxk8133565@126.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Yin Hu, MMed, RN, Chief Nurse, Department of Respiratory Medicine, Guangzhou Women and Children’s Medical Centre, No. 9 Jinsui Road, Guangzhou 510623, Guangdong Province, China. hxk8133565@126.com
Received: December 2, 2021
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
Processing time: 203 Days and 21 Hours
Abstract
BACKGROUND

It has been shown that children with Pierre Robin sequence (PRS) have a higher risk of difficult intubation before surgery. When mask ventilation or tracheobronchial intubation is expected to be challenging, flexible bronchoscopy (FB) is advantageous in airway safety when it is used to guide tracheobronchial intubation (TI).

AIM

To evaluate the complications of TI using FB in children with PRS and explore the effect of nursing services on postoperative complications.

METHODS

One hundred and five children with PRS underwent TI using FB before early mandibular distraction osteogenesis. One hundred and eight children with common pneumonia who did not have a difficult airway were set as the control group. Demographic data, success rates of TI, time required for TI, number of TI attempts, and the incidence of postoperative complications were assessed. Besides, the strategies used to attenuate complications were investigated.

RESULTS

The success rate of TI was 100% in children with PRS, while the success rate at the first attempt 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 TI in the PRS group was markedly longer than that in the control group (P < 0.001). Children in the PRS group required repetitive operations to enter the glottis successfully (P = 0.017). The incidence of complications was noticeably 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 laryngeal edema (LE) (6.7%), compared with one (0.9%) in the control group (P = 0.034). Out of the seven patients who had LE, all were reintubated and managed with steroids: six recovered with inhaled steroids alone before extubated, and one was given systemic corticosteroids before recovery.

CONCLUSION

FB contributes to a high success rate of TI in children with PRS. To prevent LE, operators should pay more attention to catheter material, catheter lubrication and intubation time.

Keywords: Clinical nursing; Pediatrics; Surgical nursing; Patient safety; Operating room

Core Tip: Flexible bronchoscopy contributes to a high success rate of tracheobronchial intubation in children with Pierre Robin sequence (PRS). Laryngeal edema (LE) is the main focus of perioperative nursing in patients with PRS. To prevent LE, surgeons should operate gently, choose the right material for the catheter, lubricate the catheter thoroughly, shorten the time required for incubation, and avoid repeated intubation.