Flowchart for selecting an appropriate surgical airway in neurologically impaired pediatric intubated patients: a case series
Objective: Medical advances have resulted in increased survival rates of neurologically impaired children who may require mechanical ventilation and subsequent tracheostomy as a surgical airway. However, at present, there is no definite consensus regarding the timing and methods for placement of a s...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-09-01
|
| Series: | Brazilian Journal of Otorhinolaryngology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1808869423000587 |
| _version_ | 1797683048522711040 |
|---|---|
| author | Mitsuyoshi Imaizumi Kazuhide Suyama Aya Goto Mitsuaki Hosoya Shigeyuki Murono |
| author_facet | Mitsuyoshi Imaizumi Kazuhide Suyama Aya Goto Mitsuaki Hosoya Shigeyuki Murono |
| author_sort | Mitsuyoshi Imaizumi |
| collection | DOAJ |
| description | Objective: Medical advances have resulted in increased survival rates of neurologically impaired children who may require mechanical ventilation and subsequent tracheostomy as a surgical airway. However, at present, there is no definite consensus regarding the timing and methods for placement of a surgical airway in a neurologically impaired intubated child who needs to be cared for over a long-term period. We therefore created a flowchart for the selection of a surgical airway for Neurologically Impaired Pediatric Patients (NIPPs). Methods: The flowchart includes information on the patients’ backgrounds, such as intubation period, prognosis related to reversibility, and history of aspiration pneumonia. To evaluate the importance of the flowchart, first we conducted a survey of pediatricians regarding selection of a surgical airway, and we also evaluated the appropriateness of the flowchart among pediatricians and caregivers through questionnaire surveys which include satisfaction with the decision-making process, and postoperative course after discharge. Results: A total of 21 NIPPs with intubation underwent surgery and a total of 24 participants (14 pediatricians and 10 caregivers) completed the survey. The answers regarding the importance of the flowchart showed that eleven pediatricians had experience selecting of surgical airways, nine of whom had had experiences in which they had to make a difficult decision. The answers regarding the appropriateness of the flowchart revealed that all pediatricians and caregivers were satisfied with the decision-making process and postoperative course after discharge using the flowchart. Conclusions: The present study demonstrated the effectiveness of our flowchart for selecting an appropriate surgical airway in NIPP. By referring to our flowchart, pediatricians and caregivers are likely to be able to select an appropriate surgical airway, leading to increased satisfaction with the decision-making process and postoperative course. Level of Evidence: 4. |
| first_indexed | 2024-03-12T00:08:50Z |
| format | Article |
| id | doaj.art-14a023a82b5d464698af0e11bdf254f4 |
| institution | Directory Open Access Journal |
| issn | 1808-8694 |
| language | English |
| last_indexed | 2024-03-12T00:08:50Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Otorhinolaryngology |
| spelling | doaj.art-14a023a82b5d464698af0e11bdf254f42023-09-16T05:30:25ZengElsevierBrazilian Journal of Otorhinolaryngology1808-86942023-09-01895101290Flowchart for selecting an appropriate surgical airway in neurologically impaired pediatric intubated patients: a case seriesMitsuyoshi Imaizumi0Kazuhide Suyama1Aya Goto2Mitsuaki Hosoya3Shigeyuki Murono4Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan; Corresponding author.Fukushima Medical University, School of Medicine, Department of Pediatrics, Fukushima, JapanFukushima Medical University, Health Information and Epidemiology Center for Integrated Science and Humanities, Fukushima, JapanFukushima Medical University, School of Medicine, Department of Pediatrics, Fukushima, JapanFukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, JapanObjective: Medical advances have resulted in increased survival rates of neurologically impaired children who may require mechanical ventilation and subsequent tracheostomy as a surgical airway. However, at present, there is no definite consensus regarding the timing and methods for placement of a surgical airway in a neurologically impaired intubated child who needs to be cared for over a long-term period. We therefore created a flowchart for the selection of a surgical airway for Neurologically Impaired Pediatric Patients (NIPPs). Methods: The flowchart includes information on the patients’ backgrounds, such as intubation period, prognosis related to reversibility, and history of aspiration pneumonia. To evaluate the importance of the flowchart, first we conducted a survey of pediatricians regarding selection of a surgical airway, and we also evaluated the appropriateness of the flowchart among pediatricians and caregivers through questionnaire surveys which include satisfaction with the decision-making process, and postoperative course after discharge. Results: A total of 21 NIPPs with intubation underwent surgery and a total of 24 participants (14 pediatricians and 10 caregivers) completed the survey. The answers regarding the importance of the flowchart showed that eleven pediatricians had experience selecting of surgical airways, nine of whom had had experiences in which they had to make a difficult decision. The answers regarding the appropriateness of the flowchart revealed that all pediatricians and caregivers were satisfied with the decision-making process and postoperative course after discharge using the flowchart. Conclusions: The present study demonstrated the effectiveness of our flowchart for selecting an appropriate surgical airway in NIPP. By referring to our flowchart, pediatricians and caregivers are likely to be able to select an appropriate surgical airway, leading to increased satisfaction with the decision-making process and postoperative course. Level of Evidence: 4.http://www.sciencedirect.com/science/article/pii/S1808869423000587FlowchartSurgical airwayTracheostomyNeurologically impaired pediatric patientAspiration prevention surgery |
| spellingShingle | Mitsuyoshi Imaizumi Kazuhide Suyama Aya Goto Mitsuaki Hosoya Shigeyuki Murono Flowchart for selecting an appropriate surgical airway in neurologically impaired pediatric intubated patients: a case series Brazilian Journal of Otorhinolaryngology Flowchart Surgical airway Tracheostomy Neurologically impaired pediatric patient Aspiration prevention surgery |
| title | Flowchart for selecting an appropriate surgical airway in neurologically impaired pediatric intubated patients: a case series |
| title_full | Flowchart for selecting an appropriate surgical airway in neurologically impaired pediatric intubated patients: a case series |
| title_fullStr | Flowchart for selecting an appropriate surgical airway in neurologically impaired pediatric intubated patients: a case series |
| title_full_unstemmed | Flowchart for selecting an appropriate surgical airway in neurologically impaired pediatric intubated patients: a case series |
| title_short | Flowchart for selecting an appropriate surgical airway in neurologically impaired pediatric intubated patients: a case series |
| title_sort | flowchart for selecting an appropriate surgical airway in neurologically impaired pediatric intubated patients a case series |
| topic | Flowchart Surgical airway Tracheostomy Neurologically impaired pediatric patient Aspiration prevention surgery |
| url | http://www.sciencedirect.com/science/article/pii/S1808869423000587 |
| work_keys_str_mv | AT mitsuyoshiimaizumi flowchartforselectinganappropriatesurgicalairwayinneurologicallyimpairedpediatricintubatedpatientsacaseseries AT kazuhidesuyama flowchartforselectinganappropriatesurgicalairwayinneurologicallyimpairedpediatricintubatedpatientsacaseseries AT ayagoto flowchartforselectinganappropriatesurgicalairwayinneurologicallyimpairedpediatricintubatedpatientsacaseseries AT mitsuakihosoya flowchartforselectinganappropriatesurgicalairwayinneurologicallyimpairedpediatricintubatedpatientsacaseseries AT shigeyukimurono flowchartforselectinganappropriatesurgicalairwayinneurologicallyimpairedpediatricintubatedpatientsacaseseries |