Premium
Upper Airway Complications in Children After Bone Marrow Transplantation
Author(s) -
Drew Brian,
Peters Charles,
Rimell Frank
Publication year - 2000
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 - 10.1097/00005537-200009000-00006
Subject(s) - medicine , intubation , airway , surgery , airway management , mechanical ventilation , incidence (geometry) , airway obstruction , otorhinolaryngology , anesthesia , physics , optics
Objective To describe the upper and lower airway complications in children during bone marrow transplantation (BMT). Study Design Review of medical records of patients requiring airway intervention during BMT over a 4‐year period. Results During the 4‐year period, 832 pediatric BMTs were performed. Of these, 87 patients (10.5%) required mechanical ventilation. Patients had intubation for a mean of 79 days (range, −7–638 d) after BMT. Patients received mechanical ventilation for a mean of 12 days (range, 1–85 d). Duration of ventilation was significantly longer in patients with difficult intubation; in these 54 patients there were 64 intubations. Of these intubations, 19 (30%) were difficult. These difficult intubations occurred in 16 (30%) patients. Patients with Hurler syndrome and congenital immunodeficiencies had significantly more difficult intubations than children with leukemia. The incidence of complications causing difficult intubation were difficulty visualizing cords, because of the presence of blood (63%); difficulty visualizing cords, because of edema (19%); anatomically narrowed airway (13%); limited neck extension (13%); and limited jaw opening (6%). The resulting mortality rate was 82% in children requiring intubation. Survivors were significantly younger than nonsurvivors. Conclusions Pediatric BMT has become increasingly more common. Airway management is rarely required during the engraftment phase, but when intervention is required, it is often difficult, particularly in the nonleukemic child, and may require the skills of an otolaryngologist. Representative cases are presented, and management is discussed.