Changes in Breathing Patterns after Surgery in Severe Laryngomalacia
Background: Most of the studies regarding the surgical treatment of severe laryngomalacia (LM) have been aimed at describing the efficacy of the treatment in terms of improvement of clinical symptoms or anatomical findings. There are no studies specifically aimed at analyzing the changes in breathin...
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MDPI AG
2021-12-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/8/12/1120 |
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| author | Fabrizio Cialente Duino Meucci Maria Luisa Tropiano Antonio Salvati Miriam Torsello Ferdinando Savignoni Francesca Landolfo Andrea Dotta Marilena Trozzi |
| author_facet | Fabrizio Cialente Duino Meucci Maria Luisa Tropiano Antonio Salvati Miriam Torsello Ferdinando Savignoni Francesca Landolfo Andrea Dotta Marilena Trozzi |
| author_sort | Fabrizio Cialente |
| collection | DOAJ |
| description | Background: Most of the studies regarding the surgical treatment of severe laryngomalacia (LM) have been aimed at describing the efficacy of the treatment in terms of improvement of clinical symptoms or anatomical findings. There are no studies specifically aimed at analyzing the changes in breathing patterns following surgical treatment for severe LM. Objective: To review the breathing pattern changes before and after corrective surgery in infants with severe LM. Study design: A series of retrospective cases at a tertiary referral children’s hospital. Methods: Retrospective chart review of 81 infants who underwent supra-glottoplasty (SGP) for severe laryngomalacia between 2011 and 2020 at Bambino Gesù Children’s Hospital of Rome, Italy. Among the patients, 47 (58%) were male and 34 (42%) were female. Twenty-one patients (26%) had one or more comorbidities condition. The data collected included age, symptoms, a polysomnography/pulse oximetry study, growth rate, the findings from flexible endoscopy, pre- and post-supra-glottoplasty (SGP) pulmonary function tests (PFTs) and, when indicated, 24 h pH-metry. Breathing patterns were studied during restful, normal sleep, using an ultrasonic flow-meter (Exhalyzer, Viasys) which measured: Tidal Volume (Vt), Respiratory Rate (RR), time to peak expiratory flow/expiratory time ratio (tPTEF/Te, an index of the patency of the lower airways) and mean expiratory/mean inspiratory flow ratio (MEF/MIF, an index of the patency of the upper airways) evaluated before surgical procedure (T1) and 3–6 weeks after (T2). Pre- and post-operative mean data were calculated and comparisons made with a Student <i>T</i>-test. Results: The surgical procedure was well tolerated by all infants and no intraoperative or post-operatory long-term complications were noted. In T1, breathing patterns were characterized by low tidal volume and high tPTEF/Te and MEF/MIF ratios, suggesting a severe reduction in the patency of the upper airways in all patients. After surgery (T2), all the previously mentioned variables significantly improved, reaching normal values for the child’s age. Conclusions: Supra-glottoplasty, as already described in several studies, is a safe and efficient procedure to treat severe laryngomalacia during infancy. The improvement in breathing patterns after surgery was reliably confirmed by a lung function test in our study, which showed the diagnostic value of testing respiratory functionality in the laryngomalacia and comparing them to clinical and endoscopic data. Moreover, considering the results obtained, we also propose the use of this available, dependable test to verify its therapeutic effects (post-surgery) and to monitor future respiratory development in these infants. Moreover, we believe that further studies will provide detailed grading guidelines for gravity of the LM, based on these functional lung tests. |
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| language | English |
| last_indexed | 2024-03-10T04:24:40Z |
| publishDate | 2021-12-01 |
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| spelling | doaj.art-44ed9924bcf84d77b896070ddcc8c7962023-11-23T07:42:13ZengMDPI AGChildren2227-90672021-12-01812112010.3390/children8121120Changes in Breathing Patterns after Surgery in Severe LaryngomalaciaFabrizio Cialente0Duino Meucci1Maria Luisa Tropiano2Antonio Salvati3Miriam Torsello4Ferdinando Savignoni5Francesca Landolfo6Andrea Dotta7Marilena Trozzi8Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, ItalyAirway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, ItalyAirway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, ItalyAirway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, ItalyAirway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, ItalyNeonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, ItalyNeonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, ItalyNeonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, ItalyAirway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, ItalyBackground: Most of the studies regarding the surgical treatment of severe laryngomalacia (LM) have been aimed at describing the efficacy of the treatment in terms of improvement of clinical symptoms or anatomical findings. There are no studies specifically aimed at analyzing the changes in breathing patterns following surgical treatment for severe LM. Objective: To review the breathing pattern changes before and after corrective surgery in infants with severe LM. Study design: A series of retrospective cases at a tertiary referral children’s hospital. Methods: Retrospective chart review of 81 infants who underwent supra-glottoplasty (SGP) for severe laryngomalacia between 2011 and 2020 at Bambino Gesù Children’s Hospital of Rome, Italy. Among the patients, 47 (58%) were male and 34 (42%) were female. Twenty-one patients (26%) had one or more comorbidities condition. The data collected included age, symptoms, a polysomnography/pulse oximetry study, growth rate, the findings from flexible endoscopy, pre- and post-supra-glottoplasty (SGP) pulmonary function tests (PFTs) and, when indicated, 24 h pH-metry. Breathing patterns were studied during restful, normal sleep, using an ultrasonic flow-meter (Exhalyzer, Viasys) which measured: Tidal Volume (Vt), Respiratory Rate (RR), time to peak expiratory flow/expiratory time ratio (tPTEF/Te, an index of the patency of the lower airways) and mean expiratory/mean inspiratory flow ratio (MEF/MIF, an index of the patency of the upper airways) evaluated before surgical procedure (T1) and 3–6 weeks after (T2). Pre- and post-operative mean data were calculated and comparisons made with a Student <i>T</i>-test. Results: The surgical procedure was well tolerated by all infants and no intraoperative or post-operatory long-term complications were noted. In T1, breathing patterns were characterized by low tidal volume and high tPTEF/Te and MEF/MIF ratios, suggesting a severe reduction in the patency of the upper airways in all patients. After surgery (T2), all the previously mentioned variables significantly improved, reaching normal values for the child’s age. Conclusions: Supra-glottoplasty, as already described in several studies, is a safe and efficient procedure to treat severe laryngomalacia during infancy. The improvement in breathing patterns after surgery was reliably confirmed by a lung function test in our study, which showed the diagnostic value of testing respiratory functionality in the laryngomalacia and comparing them to clinical and endoscopic data. Moreover, considering the results obtained, we also propose the use of this available, dependable test to verify its therapeutic effects (post-surgery) and to monitor future respiratory development in these infants. Moreover, we believe that further studies will provide detailed grading guidelines for gravity of the LM, based on these functional lung tests.https://www.mdpi.com/2227-9067/8/12/1120laryngomalaciastridorepi-glottoplastypulmonary function testairway obstructionendoscopy |
| spellingShingle | Fabrizio Cialente Duino Meucci Maria Luisa Tropiano Antonio Salvati Miriam Torsello Ferdinando Savignoni Francesca Landolfo Andrea Dotta Marilena Trozzi Changes in Breathing Patterns after Surgery in Severe Laryngomalacia Children laryngomalacia stridor epi-glottoplasty pulmonary function test airway obstruction endoscopy |
| title | Changes in Breathing Patterns after Surgery in Severe Laryngomalacia |
| title_full | Changes in Breathing Patterns after Surgery in Severe Laryngomalacia |
| title_fullStr | Changes in Breathing Patterns after Surgery in Severe Laryngomalacia |
| title_full_unstemmed | Changes in Breathing Patterns after Surgery in Severe Laryngomalacia |
| title_short | Changes in Breathing Patterns after Surgery in Severe Laryngomalacia |
| title_sort | changes in breathing patterns after surgery in severe laryngomalacia |
| topic | laryngomalacia stridor epi-glottoplasty pulmonary function test airway obstruction endoscopy |
| url | https://www.mdpi.com/2227-9067/8/12/1120 |
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