Nasopharyngeal Tube and Functional Treatment in Pierre Robin Sequence: A Tertiary Clinical Experience From 150 Cases

Objectives: To describe the initial care practices for children with Pierre Robin sequence (PRS) and analyze the factors predicting the severity of the obstruction breathing disorders. Design: A retrospective single-center study of 150 children with PRS. Setting: Single tertiary care center, Regional Competence Center for the diagnosis and treatment of PRS. Patients: A total of 150 children with PRS consecutively followed between 1986 and 2017. Group 1 comprises children without specific respiratory management; group 2, children requiring prone positioning to alleviate their respiratory distress symptoms; and group 3, children requiring nasopharyngeal airway tube (NT) or nonconservative surgical treatment. Main outcome measures: Evolution and results of the initial treatment of PRS. Results: Forty-two percent (n = 63) were attributed to group 1, 39% (n = 50) to group 2, and 19% (n = 29) to group 3. Preterm birth, birth weight, or associated congenital malformations were not significantly different between the groups. However, the age of exclusive oral feeding was significantly different: 1 day (quartiles: 0-3) for group 1; 11 days (quartiles: 1-28) for group 2; 39 days (quartiles: 19-111) for group 3 ( P < .0001). Considering the NT, its use relieves the upper airway obstruction, assessed by a respiratory polygraphy, in 14 children. Conclusions: Nasopharyngeal airway tube has become our major first-line treatment, avoiding more complex procedures in most of the cases. The achievement of exclusive oral feeding seems to be a good predictor of the severity of respiratory symptoms in PRS.

ETView VivaSight single lumen vs. conventional intubation in simulated studies: a systematic review and meta-analysis

Objective The ETView VivaSight single lumen airway tube (ETView) is a tracheal tube incorporating a video camera. We carried out a meta-analysis of previous simulation studies by inexperienced personnel to determine if the ETView could improve the success rate of first-attempt intubation. Methods We collected data from randomized controlled trials comparing the use of the ETView VivaSight single lumen versus a conventional endotracheal tube in a simulated manikin or cadaver study. Results Eleven studies (558 participants, 3,254 intubations, and 19 scenarios) were included. The ETView had a significantly higher success rate and shorter insertion time than conventional intubation in both normal airways (with or without chest compression) and in difficult airways. In addition, the ETView demonstrated better results in terms of a higher rate of Cormack−Lehane grade 1 and a lower incidence of dental trauma. Conclusions Inexperienced personnel can insert the ETView more rapidly and with a higher intubation success rate compared with a conventional tube.

Treatment of Snoring with a Nasopharyngeal Airway Tube

Objective. To study the feasibility of a standard nasopharyngeal airway tube (NPAT) as treatment for snoring.Methods. An obese 35-year-old man, who is a chronic, heroic snorer, used NPATs while (1) the patient’s bedpartner scored the snoring and (2) the patient recorded himself with the smartphone snoring app “Quit Snoring.” Baseline snoring was 8–10/10 (10 = snoring that could be heard through a closed door and interrupted the bedpartner’s sleep to the point where they would sometimes have to sleep separately) and 60–200 snores/hr. Several standard NPATs were tested, consisting of soft polyvinyl chloride material raging between 24- and 36-French (Fr) tubes.Results. The 24 Fr tube did not abate snoring. The 26 Fr tube was able to abate the snoring sound most of the night (smartphone app: 11.4 snores/hr, bedpartner VAS = 2/10). The 28 and 30 Fr tubes abated the snoring sound the entire time worn (smartphone app: 0 snores, bedpartner VAS 0/10) but could not be tolerated more than 2.5 hours. The tube of 36 Fr size could not be inserted, despite several attempts bilaterally.Conclusion. Appropriately sized nasopharyngeal airway tubes may abate the snoring sound; however, as in this patient, they may be too painful and intolerable for daily use.

Risk factors for post-extubation stridor in children: the role of orotracheal cannula

Objective To determine the risk factors associated with stridor, with special attention to the role of the cuffed orotracheal cannula. Methods Prospective analysis of all the intubated patients submitted to mechanical ventilator support from January 2008 to April 2011. The relevant factors for stridor collected were age, weight, size and type of airway tube, diagnosis, and duration of mechanical ventilation. The effects of variables on stridor were evaluated using uni- and multivariate logistic regression models. Results A total of 136 patients were included. Mean age was 1.4 year (3 days to 17 years). The mean duration of mechanical ventilation was 73.5 hours. Fifty-six patients (41.2%) presented with stridor after extubation. The total reintubation rate was 19.6% and 12.5 in patients with and without stridor, respectively. The duration of mechanical ventilation (>72 hours) was associated with a greater risk for stridor (odds ratioof 8.60; 95% confidence interval of 2.98-24.82; p<0.001). The presence of the cuffed orotracheal cannula was not associated with stridor (odds ratio of 98; 95% confidence interval of 0.46-2.06; p=0.953). Conclusion The main risk factor for stridor after extubation in our population was duration of mechanical ventilation. The presence of the cuffed orotracheal cannula was not associated with increased risk for stridor, reinforcing the use of the cuffed orotracheal cannula in children with respiratory distress.