Noninvasive Respiratory Support as an Alternative to Tracheostomy in Severe Laryngomalacia. - Université Paris Cité Accéder directement au contenu
Article Dans Une Revue Laryngoscope Année : 2021

Noninvasive Respiratory Support as an Alternative to Tracheostomy in Severe Laryngomalacia.

Résumé

Objectives/hypothesis: To analyze the role of noninvasive respiratory support (NRS) as an alternative to tracheostomy in the management of severe laryngomalacia. Study design: We conducted a monocentric retrospective study in a tertiary pediatric care center. Methods: All children under the age of 3 years with severe laryngomalacia, treated between January 2014 and December 2019, were included. Patient demographics, medical history, nutrition, surgery, NRS, and outcome were reviewed. Predictors for NRS were analyzed. Results: One hundred and eighty-eight patients were included. Mean age was 4 ± 5 months and mean weight was 4,925 ± 1,933 g. An endoscopic bilateral supraglottoplasty was performed in 183 (97%) patients and successful in 159 (87%). NRS was initiated in 29 (15%) patients at a mean age of 3 ± 2 months (1-11 months): 15 (52%) patients were treated with NRS after surgical failure, 9 (31%) were treated with NRS initiated prior to surgery because of abnormal overnight gas exchange, and 5 (17%) were treated exclusively with NRS due to comorbidities contraindicating an endoscopic procedure. NRS was successfully performed in all patients with a mean duration of 6 ± 11 months. No patient required a tracheostomy. Univariate analysis identified the following predictors of NRS: neonatal respiratory distress (P = .003), neurological comorbidity (P < .001), associated laryngeal abnormality (P < .001), cardiac surgery (P = .039), surgical endoscopic revision (P = .007), and nutritional support (P < .001). Conclusion: NRS is a safe procedure, which may avoid a tracheostomy in severe laryngomalacia, in particular, in case of endoscopic surgery failure, respiratory failure before surgery, and/or severe co-morbidity. Level of evidence: 3 Laryngoscope, 2021.
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Dates et versions

hal-03622631 , version 1 (29-03-2022)

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Elina Veroul, Alessandro Amaddeo, Nicolas Leboulanger, Matthieu Gelin, Françoise Denoyelle, et al.. Noninvasive Respiratory Support as an Alternative to Tracheostomy in Severe Laryngomalacia.. Laryngoscope, 2021, ⟨10.1002/lary.29928⟩. ⟨hal-03622631⟩

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