Systematic review/meta-analysis comparing successful outcomes after single vs. double-stage laryngotracheal reconstruction

Padia, Reema; Sjogren, Phayvanh P.; Smith, Marshall E.; Muntz, Harlan R.; Stoddard, Gregory J.; Meier, Jeremy D.

doi:10.1016/j.ijporl.2018.03.003

Cited by 35 publications

(31 citation statements)

References 28 publications

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“…This retrospective case series has shown that the use of bioabsorbable microplates as an external stent for patients with suprastomal collapse has a reasonable success rate (88%) when it comes to achieving decannulation. This is comparable to decannulation rates for other open surgical procedures in the pediatric tracheostomy population (single‐stage LTR: 93%; double‐stage LTR: 83%) 9 . Although many have described surgical procedures for suprastomal collapse in the pediatric airway, few have described the long‐term decannulation outcomes in these procedures.…”

Section: Discussionsupporting

confidence: 59%

Bioabsorbable Microplates as an External Stent for Suprastomal Collapse: A Retrospective Review

2020

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Objective/Hypothesis To assess the long‐term decannulation outcomes of bioresorbable microplates as an external stent for pediatric tracheostomy patients with suprastomal collapse. Study Design Retrospective cohort study. Methods Hospital records of all patients who underwent a bioresorbable microplate for suprastomal collapse from 2016 to 2019 were reviewed at a single institution. The primary outcome measure was tracheostomy decannulation. Results A total of nine patients underwent placement of bioabsorbable microplates to treat suprastomal collapse. After initial tracheostomy, four patients received a laryngotracheal reconstruction prior to their external stent placement, and one patient received a mandibular distraction. The average age at the time of external stent placement was 32 (±21) months, excluding one patient who received a stent at the age of 29 years. Eight patients (88.9%) were successfully decannulated following the procedure. Decannulated patients were followed for an average of 21 (±12.5) months postoperatively, and all these patients have remained decannulated since their initial procedure. This is a total of 173 months (14.4 years) of observation postprocedure in which these patients have remained decannulated. One patient experienced postoperative crepitus requiring washout but still maintained decannulation. Conclusion Bioabsorbable microplates have a reasonable chance of long‐term successful decannulation when an appropriate patient is selected. Decannulation is maintained beyond the 6‐month time frame in which the 85:15 poly(L‐lactide‐co‐glycolide) polymer that comprises the external stent takes to bioabsorb. This procedure should be considered for the often difficult problem of pediatric tracheostomy with isolated suprastomal collapse. Level of Evidence 4 Laryngoscope, 131:E631–E634, 2021

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Section: Discussionsupporting

confidence: 59%

Bioabsorbable Microplates as an External Stent for Suprastomal Collapse: A Retrospective Review

2020

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Section: Introductionmentioning

confidence: 99%

“…[1][2][3] The overall success rate for pediatric airway reconstruction is currently at an all-time high with decannulation rates exceeding 90%. 4 Nevertheless, post-operative complications continue to affect some patients, including pneumonia, atelectasis, tracheal edema, and mucous plugging. 4 All of the aforementioned problems may result in failed extubation, required reintubation, need for postoperative flexible bronchoscopy, or unexpected return to the operating room (OR).…”

Section: Introductionmentioning

confidence: 99%

“…4 Nevertheless, post-operative complications continue to affect some patients, including pneumonia, atelectasis, tracheal edema, and mucous plugging. 4 All of the aforementioned problems may result in failed extubation, required reintubation, need for postoperative flexible bronchoscopy, or unexpected return to the operating room (OR). 4 Past studies have sought to modify postoperative management strategies following pediatric airway reconstruction in order to mitigate the risk of these complications.…”

Section: Introductionmentioning

confidence: 99%

“…4 All of the aforementioned problems may result in failed extubation, required reintubation, need for postoperative flexible bronchoscopy, or unexpected return to the operating room (OR). 4 Past studies have sought to modify postoperative management strategies following pediatric airway reconstruction in order to mitigate the risk of these complications. 2,3 Although many aspects of postoperative care have been assessed, the use of prophylactic flexible bronchoscopy immediately following pediatric open airway reconstruction has not yet been studied.…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic Flexible Bronchoscopy Immediately following Open Airway Reconstruction in Children

Manayan

Haser²,

Shah

et al. 2020

Ann Otol Rhinol Laryngol

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Objectives: Prophylactic flexible bronchoscopy immediately following open airway reconstruction allows for directed clearance of the distal airways, potentially reducing the rate of certain postoperative respiratory complications. In this investigation, we sought to determine if prophylactic flexible bronchoscopy at the conclusion of pediatric open airway reconstruction has any benefit over blind flexible suctioning of the trachea. Methods: A retrospective, single-center study at an urban tertiary care hospital was completed. From January 2010 to April 2013, patients underwent open airway reconstruction, immediately followed by blind flexible suctioning of the trachea for distal airway clearance. From May 2013 through December 2016, sequential patients underwent prophylactic flexible bronchoscopy immediately following airway reconstruction. Results: A total of 29 patients (age: 3.6 months-6.2 years) met inclusion criteria. Sixteen sequential patients underwent simple blind flexible suctioning and 13 sequential patients underwent directed, prophylactic flexible bronchoscopy. Demographics and comorbidities between the groups were equivalent other than slightly older age in the prophylactic bronchoscopy group. All clinical outcomes analyzed were equivalent other than faster time to room air ( P < .002) and a decrease in the number of chest physical therapy sessions ( P < .02) in a subset of patients who did not undergo prophylactic bronchoscopy. Conclusion: This investigation suggests that the use of prophylactic flexible bronchoscopy immediately following open airway reconstruction may not be superior to blind flexible suctioning of the trachea in limiting postoperative pulmonary complications. Further studies of greater power are needed to better elucidate any small differences that may exist between these two interventions.

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Laryngotracheal Reconstruction in a Patient With a Central Conducting Lymphatic Anomaly

et al. 2020

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Systematic review/meta-analysis comparing successful outcomes after single vs. double-stage laryngotracheal reconstruction

Cited by 35 publications

References 28 publications

Bioabsorbable Microplates as an External Stent for Suprastomal Collapse: A Retrospective Review

Bioabsorbable Microplates as an External Stent for Suprastomal Collapse: A Retrospective Review

Prophylactic Flexible Bronchoscopy Immediately following Open Airway Reconstruction in Children

Laryngotracheal Reconstruction in a Patient With a Central Conducting Lymphatic Anomaly

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