Pre-extubation ultrasonographic measurement of intracricoid peritubal free space: A pilot study to predict post-extubation airway obstruction in children

Samprathi, Madhusudan; Baranwal, Arun; Gupta, Pramod Kumar; Jayashree, Muralidharan

doi:10.1016/j.ijporl.2020.110348

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…The serial mWCS was also similar in two groups during the first 48 h after extubation. The rate of PEAO (15%) in the index study was within the range of the documented rates of PEAO among critically ill children (18-40%) (20,23,(27)(28)(29). However, the rate of PEAO in index study was lower than the reported rates of Unplanned extubation, n (%) 9 ( 12 PEAO in the recent studies from our unit (32.8-34%) (21,23).…”

Section: Discussionsupporting

confidence: 59%

“…The rate of PEAO (15%) in the index study was within the range of the documented rates of PEAO among critically ill children (18–40%) ( 20 , 23 , 27 – 29 ). However, the rate of PEAO in index study was lower than the reported rates of PEAO in the recent studies from our unit (32.8–34%) ( 21 , 23 ). The lower rate of PEAO could be due to the fact that we used micro-cuffed endotracheal tubes (high-volume-low-pressure) in all cases as these were routinely available from the hospital supply during the study period.…”

Section: Discussionsupporting

confidence: 59%

“…We used modified Westley's croup score (mWCS) to monitor for PEAO at 10-timepoints (0-, 30-min, 1, 2, 3, 6, 12, 24, 36, and 48-h after extubation) ( Supplementary Table 1 ) ( 20 , 22 , 23 ). A mWCS ≥4 suggested administration of adrenaline nebulization (1 mg/ml; 2.5 ml in 2.5 ml saline every 20 min until improvement).…”

Section: Methodsmentioning

confidence: 99%

“…The sample size was calculated based on the incidence of PEAO (32.8-34%) documented in previous studies from our PICU (21,23). As a superiority trial, with the incidence of PEAO in nasotracheal group as 15% and β-error of 0.2, the required sample size was 90 cases in each group (n = 180).…”

Section: Data Entry and Statistical Analysismentioning

confidence: 99%

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Nasotracheal vs. Orotracheal Intubation and Post-extubation Airway Obstruction in Critically Ill Children: An Open-Label Randomized Controlled Trial

et al. 2021

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Background: The data on long-term nasotracheal intubation among mechanically ventilated critically ill children is limited. The purpose of this study was to compare the rate of post-extubation airway obstruction (PEAO) with nasotracheal and orotracheal intubation.Methods: This open-label randomized controlled trial was conducted in PICU of a tertiary care and teaching hospital in North India from January-December 2020 involving intubated children aged 3 months−12 years. After written informed consent, children were randomized into nasotracheal and orotracheal intubation groups. Post-extubation, modified Westley's croup score (mWCS) was used at 10-timepoints (0-min, 30 min, 1, 2, 3, 6, 12, 24, 36, and 48-h after extubation) to monitor for PEAO. The primary outcome was the rate of PEAO; and secondary outcomes were time taken for intubation, number of intubation attempts, complications during intubation, unplanned extubation, repeated intubations, tube malposition/displacement, endotracheal tube blockade, ventilator associated pneumonia, skin trauma, extubation failure/re-intubation, duration of PICU stay, and mortality.Results: Seventy children were randomized into nasotracheal (n = 30) and orotracheal (n = 40) groups. Both the groups were similar in baseline characteristics. The rate of PEAO was similar between nasotracheal and orotracheal groups (10 vs. 20%, p = 0.14). The maximum mWCS and mWCS at 10-timepoints were similar in two groups. The time taken for intubation was significantly longer (85 vs. 48 s, p < 0.001) in nasotracheal group, whereas other secondary outcomes were similar in two groups.Conclusion: The rate of PEAO was not different between nasotracheal and orotracheal groups.Clinical Trial Registration:http://ctri.nic.in, Identifier: CTRI/2020/01/022988.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionsupporting

confidence: 59%

Section: Methodsmentioning

confidence: 99%

Section: Data Entry and Statistical Analysismentioning

confidence: 99%

See 2 more Smart Citations

Nasotracheal vs. Orotracheal Intubation and Post-extubation Airway Obstruction in Critically Ill Children: An Open-Label Randomized Controlled Trial

et al. 2021

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“…Trials to assess the effectiveness of dexamethasone pretreatment regimens in high-risk children from our setting are required in context of decreasing incidence of PEAO and plateauing incidence of reintubation over the last decade. Indices based on pre-extubation airway ultrasound [17][18][19][20] may help identify high-risk children.…”

Section: Discussionmentioning

confidence: 99%

Twenty‐four‐hour pretreatment with low dose (0.25 mg/kg/dose) versus high dose (0.5 mg/kg/dose) dexamethasone in reducing the risk of postextubation airway obstruction in children: A randomized open‐label noninferiority trial

Parajuli

Baranwal

Kumar‐M

et al. 2021

Pediatric Pulmonology

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Objective: Multidose dexamethasone pretreatment reduces risk of postextubation airway obstruction (PEAO). However, its optimal dose is not known. We planned to compare 24 h pretreatment with low-dose dexamethasone (LDD) (0.25 mg/kg/dose) versus high-dose dexamethasone (HDD) (0.5 mg/kg/dose) in reducing risk of PEAO.Design: Stratified (for age and intubation duration) randomized open-label noninferiority trial.Setting: Fifteen-bed pediatric intensive care unit in a lower-middle-income country.Patients: Children (3 months-12 years) intubated for more than or equal to 48 h and planned for first extubation . Upper airway conditions, chronic respiratory diseases, chronic NSAID therapy, steroid, or intravenous immunoglobulin in the last 7 days, presence of gastrointestinal bleeding, hypertension, and hyperglycemia were exclusions.Interventions: LDD (n = 144) or HDD (n = 143) (q6h) for a total of six doses.

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High Flow Nasal Cannula Versus Conventional Oxygen Therapy and Incidence of Post-Extubation Airway Obstruction in PICU: An Open-Label Randomized Controlled Trial (HiFloCOT-PICU Trial)

Sudeep,

Angurana,

Nallasamy

et al. 2024

Indian J Pediatr

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Pre-extubation ultrasonographic measurement of intracricoid peritubal free space: A pilot study to predict post-extubation airway obstruction in children

Cited by 7 publications

References 21 publications

Nasotracheal vs. Orotracheal Intubation and Post-extubation Airway Obstruction in Critically Ill Children: An Open-Label Randomized Controlled Trial

Nasotracheal vs. Orotracheal Intubation and Post-extubation Airway Obstruction in Critically Ill Children: An Open-Label Randomized Controlled Trial

Twenty‐four‐hour pretreatment with low dose (0.25 mg/kg/dose) versus high dose (0.5 mg/kg/dose) dexamethasone in reducing the risk of postextubation airway obstruction in children: A randomized open‐label noninferiority trial

High Flow Nasal Cannula Versus Conventional Oxygen Therapy and Incidence of Post-Extubation Airway Obstruction in PICU: An Open-Label Randomized Controlled Trial (HiFloCOT-PICU Trial)

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