Tracheobronchial intubation using flexible bronchoscopy in children with Pierre Robin sequence: Nursing considerations for complications

Ying-Long Ye; Cai-Feng Zhang; Li-Zhen Xu; Hui-Feng Fan; Jun-Zheng Peng; Gen Lu; Xiao-Yin Hu

doi:10.12998/wjcc.v10.i19.6464

Tracheobronchial intubation using flexible bronchoscopy in children with Pierre Robin sequence: Nursing considerations for complications

World J Clin Cases. 2022 Jul 6;10(19):6464-6471. doi: 10.12998/wjcc.v10.i19.6464.

Authors

Ying-Long Ye¹, Cai-Feng Zhang¹, Li-Zhen Xu¹, Hui-Feng Fan¹, Jun-Zheng Peng¹, Gen Lu¹, Xiao-Yin Hu²

Affiliations

¹ Department of Respiratory Medicine, Guangzhou Women and Children's Medical Centre, Guangzhou 510623, Guangdong Province, China.
² Department of Respiratory Medicine, Guangzhou Women and Children's Medical Centre, Guangzhou 510623, Guangdong Province, China. hxk8133565@126.com.

Abstract

Background: It has been shown that children with Pierre Robin sequence (PRS) have a higher risk of difficult intubation before surgery. When mask ventilation or tracheobronchial intubation is expected to be challenging, flexible bronchoscopy (FB) is advantageous in airway safety when it is used to guide tracheobronchial intubation (TI).

Aim: To evaluate the complications of TI using FB in children with PRS and explore the effect of nursing services on postoperative complications.

Methods: One hundred and five children with PRS underwent TI using FB before early mandibular distraction osteogenesis. One hundred and eight children with common pneumonia who did not have a difficult airway were set as the control group. Demographic data, success rates of TI, time required for TI, number of TI attempts, and the incidence of postoperative complications were assessed. Besides, the strategies used to attenuate complications were investigated.

Results: The success rate of TI was 100% in children with PRS, while the success rate at the first attempt in the PRS group was significantly lower than that in the control group (88.6% vs 98.2%, P = 0.005). The time required for TI in the PRS group was markedly longer than that in the control group (P < 0.001). Children in the PRS group required repetitive operations to enter the glottis successfully (P = 0.017). The incidence of complications was noticeably higher in the PRS group (50/105, 47.6%) than in the control group (36/108, 33.3%) (P = 0.034). Seven of 105 PRS children experienced laryngeal edema (LE) (6.7%), compared with one (0.9%) in the control group (P = 0.034). Out of the seven patients who had LE, all were reintubated and managed with steroids: six recovered with inhaled steroids alone before extubated, and one was given systemic corticosteroids before recovery.

Conclusion: FB contributes to a high success rate of TI in children with PRS. To prevent LE, operators should pay more attention to catheter material, catheter lubrication and intubation time.

Keywords: Clinical nursing; Operating room; Patient safety; Pediatrics; Surgical nursing.