Abstract
PurposeTo evaluate a comprehensive scoring system which combines clinical manifestations of Pierre Robin Sequence (PRS) including severity of breathing difficulties, body weight and preoperative Cormack-Lehane grade, for its correlation with perioperative PRS airway management decision.DesignForty PRS children were retrospectively recruited after surgery. Specialists examined all subjects and scored for clinical manifestations (1´ - 4´), weight gain (1´- 4´), dyspnea scores (1´- 4´), and Cormack-Lehane grade (1´- 4´). The correlation of the integrated scores and the necessity of endotracheal intubation or laryngeal mask application were analyzed. In addition, the score correlation with postoperative dyspnea and/or low pulse oxygen saturation (SPO2) levels after extubation was determined.FindingsIn our study every individual patient had a score from 0´ to 16´, while the higher in the numbers represented higher risk of breathing difficulty. All patients with comprehensive scores <10 points underwent endotracheal intubation successfully. Patients scoring 10–12 points had an intubation success rate of 47%, whereas all patients scored >13 points required a laryngeal mask assisted airway management and were considered to have difficult airways. Dyspnea after extubation and postoperative low SPO2 occurred among patients who scored over 10 points.ConclusionIn PRS patients, preoperative weight gaining status and severity of dyspnea in combination with Cormack-Lehane classification provide a scoring system that could help to optimize airway management decisions such as endotracheal intubation or laryngeal mask airway placement and has the potential to predict postoperative dyspnea or low SPO2 levels.
Highlights
The Pierre Robin Sequence (PRS) was first described in 1923, by a French stomatologist
Infants with PRS are characterized by mandibular hypotrophy and glossoptosis, which result in serious airway obstruction and feeding difficulties
It is estimated that around 70% of PRS patient with mild airway obstruction could be successfully managed by supine positioning
Summary
The Pierre Robin Sequence (PRS) was first described in 1923, by a French stomatologist. Infants with PRS are characterized by mandibular hypotrophy (micrognathia) and glossoptosis (abnormal posterior placement of the tongue), which result in serious airway obstruction and feeding difficulties. Other clinical features may include a soft or high-arched cleft palate, and a typical "bird face" appearance due to the shortened length of the lower jaw [1, 2]. This is a neonatal disease with an occurrence around 1:8500 to 14,000 at births. From moderate to severe PRS patients that fail to respond to conservative treatment, additional interventions are necessary. PRS children may develop poor nutritional status, inability of gaining weight, and slow growth
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