Outcomes Using a Postoperative Protocol in Pediatric Single-Stage Laryngotracheal Reconstruction.
OBJECTIVES
The aim of this study was to evaluate single-stage laryngotracheal reconstruction (ssLTR) outcomes before and after the implementation of a postoperative care protocol in pediatric patients.


METHODS
A case-control study with chart review was conducted at 2 tertiary academic centers from 2010 to 2016. Pediatric patients who underwent ssLTR with a postoperative care protocol were compared with those who did not receive care under this protocol. Data regarding perioperative management were collected and compared using χ2 and Wilcoxon rank tests. Planned extubation, length of intubation in the intensive care unit, and complications were examined.


RESULTS
Nineteen patients completed ssLTR after the protocol was initiated, and 26 prior patients were used as control subjects. Planned extubation failed in 9 patients (35%) in the control group compared with 1 patient (5%) in the protocol group (P < .05). Using a structured protocol demonstrated a decrease in delayed extubation and intensive care unit stay (P < .05). Despite more postprotocol patients' requiring posterior graft placement, preprotocol patients were less likely to be extubated within 7 days (P < .05).


CONCLUSIONS
The authors propose an intensive care unit protocol that uses a combination of pharmacologic agents to optimally reduce the risk for adverse events that delay time to extubation and thus decannulation. Timely extubation was more likely with the use of this postoperative care protocol using a multidisciplinary approach involving otolaryngologists, pharmacists, intensivists, and anesthesiologists.
['Thottam|Prasad John|PJ|https://orcid.org/0000-0003-2320-9977', 'Gilliland|Taylor|T|https://orcid.org/0000-0003-0116-0412', 'Ettinger|Nicholas|N|https://orcid.org/0000-0002-0388-7693', 'Baijal|Rahul|R|', 'Mehta|Deepak|D|']
D060666:Airway Extubation D016022:Case-Control Studies D002648:Child D002675:Child, Preschool D002985:Clinical Protocols D003422:Critical Care D005260:Female D006801:Humans D007223:Infant D007829:Laryngostenosis D007902:Length of Stay D008297:Male D011182:Postoperative Care D019651:Reconstructive Surgical Procedures D014135:Tracheal Stenosis
intensive care airway reconstruction child laryngeal stenosis pediatric airway treatment outcomes