Discussion on the challenges and collaboration in managing pediatric patients with complex airway issues. Treatment options for severe airway stenosis and malformations. Assessment and workup process for complex airway patients. Challenges of maintaining non-sick lungs in sedated children. Benefits of using micro cuff tube and rigid endoscope in complex airway surgeries. Approaching airway complications and post-extubation care. Criteria for escalating non-invasive support in pediatric patients after extubation.
Collaboration between ICU and surgical teams is crucial in complex airway surgery, necessitating a multidisciplinary approach involving various medical specialists.
Thorough preoperative evaluation, including inspiratory airway CT and endoscopic examination, is essential in planning airway reconstruction surgeries.
Meticulous surgical techniques and careful management are necessary to avoid complications and address potential challenges during and after airway surgery.
Deep dives
Working up and investigating patients for complex airway surgery
In this podcast episode on complex airway surgery, the speakers discuss the process of working up and investigating patients for these procedures. They emphasize the importance of collaboration between ICU and surgical teams, as well as the need for a multidisciplinary approach involving various medical specialists. The speakers highlight the range of conditions that can be treated, such as severe stenosis and malacia, and the innovative techniques used, including the use of external airway splints. They also mention the significance of thorough preoperative evaluation, including inspiratory airway CT and endoscopic examination.
Maintaining and managing patients in the ICU after airway surgery
The podcast episode delves into the crucial aspects of maintaining and managing patients in the ICU following airway surgery. The speakers discuss the complexities involved in post-operative care, especially in cases of severe malacia or stenosis. They highlight the need for vigilance in monitoring the patient's respiratory status, fluid balance, and medication levels. The speakers mention the challenges of balancing sedation and paralysis to ensure patient comfort and healing. Additionally, they note the use of appropriate ventilation modes and the importance of collaboration with an otolaryngology team for effective post-operative management.
Special considerations and innovations in airway reconstruction
The podcast episode emphasizes the importance of considering individual patient factors when planning airway reconstruction surgeries. The speakers discuss the various complexities that may arise, such as the presence of syndromes or neurological conditions. They mention the use of external splints for severe malacia and the need for caution in cases involving granulation tissue or tension on suture lines. The speakers also highlight the innovative use of techniques like converting the esophagus into a functional airway. They stress the significance of precise tube placement, the use of rigid endoscopes, and collaborative decision-making between ICU and surgical teams.
Challenges and potential complications in airway surgery
The podcast episode addresses potential challenges and complications that may arise during airway surgery and their subsequent management. The speakers express the importance of meticulous surgical techniques to avoid complications such as dehiscence or tension on suture lines. They discuss the rarity of severe complications like pneumothorax or significant bleeding, but note the need for immediate investigation and intervention if they occur. The speakers also touch upon the impacts of respiratory infections and the complexities of operating during cold and flu season. Lastly, they discuss the need for individualized post-extubation care and potential escalation to non-invasive or extracorporeal support if necessary.
Collaboration and planning in airway reconstruction surgeries
The podcast episode highlights the importance of collaboration and planning among the surgical and ICU teams in airway reconstruction surgeries. The speakers discuss the selection of single-stage or double-stage reconstructions based on the patient's condition and the surgeon's experience. They emphasize the need for clear communication and coordination during the surgical procedures, involving ENT surgeons, cardiovascular surgeons, and specialized airway teams. The speakers also mention the careful consideration given to extubation timing and the availability of resources such as airway towers and rigid endoscopes. They stress the significance of regular team meetings to discuss cases, plan procedures, and ensure optimal patient care.
Children with complex airway surgery are airways that truly scare us. Though a small number of patients in pedsICU, they can stay a long time and are at risk of death and morbidity from their underlying conditions, co-existing conditions, their treatment and ICU acquired problems. Managing these patients requires a high level of understanding, communication and teamwork between ENT/ORL, ICU, anesthesia, cardiothoracic surgery and numerous other teams.
We're going to cover the working up and investigation of patients transfers. The kind of conditions that are treated ranging from severe stenoses to severe malacias. What the surgeons actually do what they want us to know and how it can best work together between ICU and surgical team. We're also going to cover how we maintain these patients in the ICU, how we progress them, forwards, how we investigate problems and how we get the next debated and keep them safe.
Featuring special guests ORL surgeon and innovator David Zopf and Ryan Barbaro from University of Michigan and regular hosts @drpetaalexander @BostonChildrens @drgregkelly @SCHNkids and Mike Clifford @RCH
No time to listen or want to participate in the discusion? You can find a full Tweetorial of this episode on Twitter @pedsintensiva and our website here https://pedsintensiva.com
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