Postintubation Croup in Children

Koka, Babu V.; Jeon, In Sik; Andre, Josiane M.; MacKAY, Isobel; Smith, Robert M.

doi:10.1213/00000539-197707000-00008

Cited by 170 publications

(66 citation statements)

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“…We sought to describe some potential risk factors in our study. From our data, patients with UAO had lower median age and weight than those without UAO, which is only marginally consistent with other studies 3,4,6,16,17 . However, this was not true when looking at only cases of “Definite” UAO.…”

Section: Discussionsupporting

confidence: 91%

Pediatric upper airway obstruction: Interobserver variability is the road to perdition

Khemani

Schneider

Morzov

et al. 2013

Journal of Critical Care

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Purpose To determine the inter-observer variability in the clinical assessment of pediatric upper airway obstruction (UAO). To explore how variability in assessment of UAO may contribute to risk factors and incidence of post-extubation UAO. Materials Prospective trial in two tertiary care Pediatric intensive care units. Bedside practitioners performed simultaneous, blinded UAO assessments on 112 children after endotracheal extubation. Results Agreement amongst RTs, RNs and MDs was poor for cyanosis (kappa (κ) =0.01), and hypoxemia at rest (κ =0.14); and fair for consciousness (κ =0.27), air entry (κ =0.32), hypoxemia with agitation (κ =0.27), and pulsus paradoxus (κ =0.23). When looking at “stridor” and “retractions,” defined using more than 2 grades of severity from the Westley Croup Score, the inter-relater reliability was moderate (κ =0.43 and κ =0.47, respectively). This could be improved marginally by dichotomizing the presence or absence of stridor (κ =0.54) or retractions (κ =0.53). The overall incidence of UAO after extubation (stridor plus retractions) could range from 7–22%, depending on how many providers were required to agree. Conclusions Physical findings routinely used for UAO have poor inter-observer reliability amongst bedside providers. This variability may contribute to inconsistent findings regarding incidence, risk factors, and therapies for post-extubation UAO.

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Section: Discussionsupporting

confidence: 91%

Pediatric upper airway obstruction: Interobserver variability is the road to perdition

Khemani

Schneider

Morzov

et al. 2013

Journal of Critical Care

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“…Clinical sludies attempting to elucidate cause-effect relationships between the administration of anaesthesia and the development of perioperative complications in patients harbouring viral infections have for the most part been empirical in nature, whereas many animal studies have involved the use of anaesthetics which are no longer in use. [1][2][3][4] Traditionally, for elective procedures, anaesthetists are taught to avoid anaesthetizing patients who harbour viral infections. This is particularly true of patients presenting with infections of the upper respiratory tract (URIs).…”

mentioning

confidence: 99%

Intraoperative respira-tory complications in patients with upper respiratory tract infections

Tait

Knight

1987

Can J Anaesth

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“…In children, laryngeal edema is promoted by a tight-fitting ETT, traumatic intubation, intubation longer than 1 hour, coughing on the tracheal tube, and intraoperative alterations of head position. 94 Koka and coworkers found an incidence of 1% among children younger than 17 years. Laryngeal edema should be suspected when inspiratory stridor develops within 6 hours of extubation.…”

Section: Laryngeal Edemamentioning

confidence: 99%