Airway Management following Pediatric Cardiothoracic Surgery

Abstract

Objective: Little is currently known regarding outcomes in airway management of pediatric patients following cardiothoracic surgery (CTS). This study aims to 1) review airway management in a large cohort of pediatric patients undergoing CTS and 2) determine the incidence of airway related complications of CTS in this population. Method: All patients who underwent CTS at a single, tertiary care, dedicated children’s hospital between June 1, 2007, and May 31, 2011, were retrospectively reviewed; those <18 years old who had open CTS were included. Statistical analysis examined the relationships of intubation length, tracheotomy, and complications compared to patient characteristics, comorbidities, and type of surgery. Results: Nine hundred five admissions in 762 patients met inclusion criteria. Mean postoperative intubation duration was 7.2 days (d), and the median was 3 d. Significantly longer postoperative intubation requirements were found in patients <2 years (mean 9.7 d, median 4 d) vs >2 years (mean 2.4 d, median 2 d, P < .001) and those with comorbidities (mean 11.0 d, median 4 d) or history of prematurity (mean 8.8 d, median 4 d) vs those without comorbidity (mean 5.5 d, median 3 d, P < .001). Additionally, preoperative intubation and surgical incision type significantly affected intubation duration. Vocal cord paralysis occurred in 3 patients, and phrenic nerve palsy occurred in 5. Twenty-four patients required tracheotomy. Five patients developed airway stenosis. Conclusion: After reviewing a large cohort of patients, this study finds CTS in the pediatric population is associated with few long term or permanent airway related complications. Patients with a history of prematurity, medical comorbidity, and/or younger age at the time of surgery require longer periods of postoperative intubation.