New Approaches to Managing Airway Disease in Children Anna K. - - PDF document
New Approaches to Managing Airway Disease in Children Anna K. Meyer, MD, FAAP Assistant Professor Division of Pediatric Otolaryngology University of California, San Francisco February 2013 No disclosures 2 1 Overview
Anna K. Meyer, MD, FAAP Assistant Professor Division of Pediatric Otolaryngology University of California, San Francisco
February 2013
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*time-permitting
– Small ETT – Uncuffed ETT – Reduced Intubation
– Reducing infection
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Jatana, et al., 2010
– Maximize radial direction – Less shearing vertical damage to airway
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……all noisy breathing is not laryngomalacia.
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– Severity – Progression/ Phase – Eating – Cyanosis/ apneas – Sleeping – Radiologic review
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– Pyriform aperture stenosis – Choanal atresia – Lacrimal duct cyst – Nasopharyngeal mass – Facial skeletal abnormalities – Base of tongue mass – Adenotonsillar hypertrophy – macroglossia
– Laryngomalacia – Vocal cord paralysis – Saccular cysts – Webs – Respiratory papillomas – Subglottic hemangiomas – Subglottic stenosis – Laryngeal cleft – Foreign body
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Tracheobronchial – Tracheomalacia, bronchomalacia – Vascular anomalies – Stenosis – Foreign body – TEF – Bronchiolitis, bronchitis
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Flexible laryngoscopy
High kilovoltage, magnified airway films
Airway fluoroscopy
Swallow studies
Rigid endoscopy – which patients? Classic Laryngomalacia Inspiratory-only Stridor No work of breathing Normal weight gain No OSA Normal AP films Re-evaluation in one month
Mancuso, et al., 1996
Inconsistent with Laryngomalacia Expiratory or biphasic stridor Work of breathing Poor weight gain Abnormal AP films Supraglottoplasty Rigid endoscopy
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9 weeks old Post-4 weeks of systemic corticosteroids
Léauté-Labrèze C et al June 12, 2008
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10 weeks old post-7 days propranolol
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6 months age steroids discontinued at 2 mos
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9 mos age propranolol discontinued
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At admission 6 days post-propranolol
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Vijayasekaran, et al., 2006; O- Lee & Messner, 2008
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– SDB often is multifactorial – Effective in 60-70% of children with significant tonsillar hypertrophy – Only effective in 10 – 25% of complex children
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Durr, Meyer, Rosbe, 2012; Koltai, 2012
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– Tracheotomy – Vocal cord suture lateralization – Injection vocal cord augmentation
– Endoscopic posterior graft – Arytenoidectomy – Cordotomy – Thyroplasty – Reinnervation
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Chen & Inglis, 2011
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Matthur, et al., 2004
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