Objective

To determine demographic and peri-operative characteristics that predict peri-operative respiratory adverse events (PRAE) requiring intensive care unit (ICU) level intervention after supraglottoplasty.

Study design

Case series with chart review.

Setting

Tertiary care children's hospital.

Methods

Retrospective chart review was conducted of children with laryngomalacia who underwent supraglottoplasty between October 2014 and November 2019. PRAE were defined as any of the following events or requirements within 24 h of surgery: 1) failure to extubate, 2) reintubation, 3) positive pressure ventilation, 4) more than one dose of racemic epinephrine, or 5) greater than 4 L of oxygen via nasal cannula.

Results

Fifty-one subjects were enrolled, with a median age of 4.8 months and majority (62 %) Hispanic. Twenty-one (41 %) subjects experienced PRAE. After adjusting for age and gender on multivariate analysis, children admitted preoperatively to the ICU were more likely to have PRAE than those not admitted or admitted to a floor unit (OR 40.1, 95%CI: 4.1–388.6, p = 0.001). Additionally, children with intraoperative oxygen desaturations below 90 % for greater than 1 min were more likely to have PRAE than those who did not (OR 21.3, 95%CI: 2.4–189.9, p = 0.006). Other factors significantly associated with PRAE on univariate analysis included chronic lung disease, congenital cardiac abnormality, history of intubation, supplemental oxygen requirement, gastrostomy tube dependence, intraoperative intubation and longer surgery length.

Conclusion

Preoperative ICU admission and intraoperative oxygen desaturations are independent risk factors for PRAE after supraglottoplasty. Results from this study can help inform decisions regarding the appropriate level of postoperative care required after supraglottoplasty.

Level of evidence

IV.

中文翻译：

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声门上成形术后围手术期呼吸系统不良事件的危险因素

客观的

确定预测声门上成形术后需要重症监护室 (ICU) 级别干预的围手术期呼吸不良事件 (PRAE) 的人口统计学和围手术期特征。

学习规划

带有图表审查的案例系列。

环境

三级儿童医院。

方法

对 2014 年 10 月至 2019 年 11 月期间接受声门上成形术的喉软化症患儿进行回顾性图表审查。 PRAE 定义为手术 24 小时内发生以下任何事件或要求：1）拔管失败，2）再次插管，3）正压通气，4) 超过一剂外消旋肾上腺素，或 5) 通过鼻插管提供超过 4 L 的氧气。

结果

招募了 51 名受试者，中位年龄为 4.8 个月，大多数 (62 %) 是西班牙裔。二十一名 (41 %) 受试者经历了 PRAE。在多变量分析中调整年龄和性别后，术前入住 ICU 的儿童比未入住或入住楼层病房的儿童更容易发生 PRAE（OR 40.1，95%CI：4.1–388.6，p = 0.001）。此外，术中氧饱和度低于 90% 且持续时间超过 1 分钟的儿童比没有出现 PRAE 的儿童更有可能发生 PRAE（OR 21.3，95%CI：2.4–189.9，p = 0.006）。在单变量分析中与 PRAE 显着相关的其他因素包括慢性肺病、先天性心脏异常、插管史、补充氧气需求、胃造瘘管依赖、术中插管和较长的手术时间。

结论

术前入住ICU和术中氧饱和度下降是声门上成形术后PRAE的独立危险因素。这项研究的结果可以帮助决定声门上成形术后所需的适当术后护理水平。

证据水平

四、