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Assessing Pediatric Post-Extubation Upper Airway Obstruction

Assessing Pediatric Post-Extubation Upper Airway Obstruction

Data indicate that subglottic edema is among the most common complications experienced by children who require mechanical ventilation. Observational studies suggest that post-extubation upper airway obstruction (UAO) is the cause of one-third to one-half of re-intubation cases in children. However, risk factors and prevention strategies for post-extubation UAO have not been well defined. “Post-extubation UAO can result from subglottic or superglottic obstruction, for which the risk factors and impact on outcomes are substantially different,” explains Robinder G. Khemani, MD, MsCI. “However, few studies have differentiated these two types of UAO, making prevention efforts difficult.”   Shedding New Light For a study of children receiving mechanical ventilation—published in the American Journal of Respiratory and Critical Care Medicine—Dr. Khemani and colleagues had two goals. First, they wanted to determine whether a diagnostic technique they created—which uses esophageal manometry and respiratory inductance plethysmography (RIP) bands calibrated to measure airflow—was superior to clinicians in assessing patients who went on to receive treatment of UAO or be re-intubated and could differentiate subglottic from supraglottic UAO. The second goal was to use the allocation of subglottic versus supraglottic UAO created with this technique to identify risk factors for subglottic edema after extubation, stratified by cuffed versus uncuffed endotracheal tubes (ETTs). The researchers found that 12% of participants had supraglottic UAO and 12% had subglottic UAO. “Considering that these rates are relatively high for both types of UAO, helping differentiate them is important,” says Dr. Khemani. “The prevention, treatment strategies, and risk factors are different for each type. Subglottic UAO is a bigger problem than supraglottic. Patients with post-extubation subglottic UAO are much more likely to...
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