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Positive airway pressure ventilation and complications in pediatric tracheocutaneous fistula repair
Author(s) -
Smith Joshua D.,
Thorne Marc C.,
Thatcher Aaron L.
Publication year - 2020
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.27834
Subject(s) - medicine , pneumomediastinum , subcutaneous emphysema , pneumothorax , surgery , anesthesia , fistula , continuous positive airway pressure , airway , respiratory distress , intubation , positive pressure , obstructive sleep apnea
Objectives Surgical repair of persistent tracheocutaneous fistula in children may be complicated by tracheal air leak with resultant subcutaneous emphysema, pneumomediastinum, and/or pneumothorax. We first sought to identify clinical risk factors for postoperative complications after primary repair of persistent tracheocutaneous fistula in children. Second, the type and frequency of complications in patients administered positive airway pressure ventilation (e.g., bag‐valve mask ventilation, continuous positive airway pressure [CPAP], or bilevel positive airway pressure [BiPAP]) postoperatively was determined and compared to a control population. Methods This was a retrospective investigation of all pediatric patients (n = 108) undergoing surgical repair of persistent tracheocutaneous fistula from January 2000 and April 2016 at a tertiary, academic referral center. Type and frequency of postoperative complications were compared among patients who were administered positive airway pressure ventilation postoperatively versus those who were not. Results Of 108 pediatric patients, complications after tracheocutaneous fistula repair occurred in 22 (20.4%) patients. These included symptoms of respiratory distress requiring intervention (e.g., supplemental O 2 , racemic epinephrine, intubation), subcutaneous emphysema, pneumomediastinum and/or pneumothorax, bleeding, wound infection, and readmission. Frequency of all postoperative complications was significantly higher in patients administered positive airway pressure ventilation versus those who were not (50.0% vs. 16.7%, P = 0.015 ), as were rates of subcutaneous emphysema, pneumomediastinum, and/or pneumothorax (33.3% vs. 4.2%, P = 0.005). Conclusion Positive airway pressure ventilation after primary repair of persistent tracheocutaneous fistula in children may increase risk of serious respiratory complications. In practice, we advocate for avoidance of bag‐valve mask ventilation and caution when utilizing CPAP or BiPAP postoperatively in these patients. Level of Evidence 4 Laryngoscope , 130:E30–E34, 2020