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Management of oral feeding in children undergoing airway reconstruction
Author(s) -
Smith Lee P.,
Otto Staci E.,
Wagner Kathrine A.,
Chewaproug Linda,
Jacobs Ian N.,
Zur Karen B.
Publication year - 2009
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.20212
Subject(s) - medicine , swallowing , dysphagia , perioperative , airway management , airway , surgery , tongue , retrospective cohort study , stage (stratigraphy) , pathology , paleontology , biology
Objectives: To systematically evaluate perioperative management of oral feeding in children undergoing airway reconstruction. Study Design: A retrospective chart review of all patients who underwent open airway reconstruction from February 1, 2006 through July 31, 2008 at a tertiary care children's hospital. Methods: During the study period, a multidisciplinary protocol for perioperative management of alimentation was instituted. Swallowing function was evaluated pre‐ and postoperatively as part of a clinical management protocol. Results: Fifty‐one patients underwent 55 reconstructions. Forty‐eight of the patients (94%) have been decannulated. Eighteen single‐stage procedures were performed on patients who were considered oral feeders, and oral feeding was successfully completed for three patients while the endotracheal tube was in place. Twenty‐two double‐stage procedures were performed on patients who were considered oral feeders. Oral feeding was initiated while the stent was in place for 16 patients. Nine patients (56%) did not tolerate oral feeding with the stent in place, five of whom had evidence of gross aspiration. Thirty‐four of the 40 patients (85%) who were considered oral feeders at the time of their reconstruction returned to their preoperative diet with minimal therapy from the speech pathology service 1.9 days (range, 0–8 days) following extubation or stent removal. Six patients (15%) had clinically significant dysphagia. Conclusions: Safe oral alimentation early in the postoperative period is possible with a rigorous multidisciplinary approach. To minimize complications, postoperative oral feeding should be initiated in conjunction with a speech pathologist. Laryngoscope, 2009