Airway Management and Risk Factors for Prolonged Intubation in Patients with Severe Croup

Abstract

Croup is a common respiratory illness in children with a substantial variation in the severity of symptoms. Most of the patients present with mild symptoms, but patients with severe croup require intensive care unit (ICU) management. The aim of this study was to investigate the airway management of patients with severe croup who required intubation and determine the risk factors for prolonged intubation. We performed an 18-year retrospective observational cohort study at the pediatric ICU of a tertiary children's hospital in Japan. A total of 16 patients with croup who were intubated for upper airway obstruction were included in the study. Most patients (13of 16, 81%) were intubated with an endotracheal tube (ETT) smaller than their age-appropriate size. The median difference in the internal diameter (ID) between the selected ETT and the age-appropriate size was 1.0 mm (interquartile range: 0.5–1.0). Multivariate analysis performed on factors affecting the cumulative incidence of extubation revealed that the difference in ID between the selected ETT and age-appropriate size (mm) significantly reduced the duration of intubation (hazard ratio: 0.092, p = 0.03). A downsized ETT without a cuff may be recommended for intubation of patients with croup.

Keywords

severe croup - airway management - endotracheal tube size

Publikationsverlauf

Eingereicht: 03. Mai 2021

Angenommen: 09. September 2021

Artikel online veröffentlicht:
25. Oktober 2021

• References

• 1 Tyler A, McLeod L, Beaty B. et al. Variation in inpatient croup management and outcomes. Pediatrics 2017; 139 (04) e20163582
• 2 Asmundsson AS, Arms J, Kaila R. et al. Hospital course of croup after emergency department management. Hosp Pediatr 2019; 9 (05) 326-332
• 3 Gelbart B, Parsons S, Sarpal A, Ninova P, Butt W. Intensive care management of children intubated for croup: a retrospective analysis. Anaesth Intensive Care 2016; 44 (02) 245-250
• 4 Westley CR, Cotton EK, Brooks JG. Nebulized racemic epinephrine by IPPB for the treatment of croup: a double-blind study. Am J Dis Child 1978; 132 (05) 484-487
• 5 Marx A, Török TJ, Holman RC, Clarke MJ, Anderson LJ. Pediatric hospitalizations for croup (laryngotracheobronchitis): biennial increases associated with human parainfluenza virus 1 epidemics. J Infect Dis 1997; 176 (06) 1423-1427
• 6 Sofer S, Dagan R, Tal A. The need for intubation in serious upper respiratory tract infection in pediatric patients (a retrospective study). Infection 1991; 19 (03) 131-134
• 7 Brooks P, Ree R, Rosen D, Ansermino M. Canadian pediatric anesthesiologists prefer inhalational anesthesia to manage difficult airways. Can J Anaesth 2005; 52 (03) 285-290
• 8 Mencke T, Echternach M, Kleinschmidt S. et al. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology 2003; 98 (05) 1049-1056
• 9 Baillard C, Adnet F, Borron SW. et al. Tracheal intubation in routine practice with and without muscular relaxation: an observational study. Eur J Anaesthesiol 2005; 22 (09) 672-677
• 10 Ezri T, Boaz M, Sherman A, Armaly M, Berlovitz Y. Sugammadex: an update. J Crit Care Med (Targu Mures) 2016; 2 (01) 16-21
• 11 Eric Fleegler, Monica Kleinman. Management of respiratory distress and failure. In: Pediatric Advanced Life Support Provider Manual. Guidelines 2015 CPR and ECC. Dallas: American Heart Association; 2016: 129-170
• 12 Polese G, D'Angelo E, Rossi A, Milic-Emili J. Effect of inspiratory flow waveform on work on endotracheal tubes: a model analysis. Intensive Care Med 1999; 25 (05) 503-507