Utility of fiberoptic bronchoscopy for difficult airway in neonates

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dc.contributor.author Cobo, P.
dc.contributor.author Vetter-Laracy, S.
dc.contributor.author Beltran, E.
dc.contributor.author Peña-Zarza, J.A.
dc.contributor.author Figuerola, F.
dc.contributor.author Osona, B.
dc.date.accessioned 2020-01-23T09:49:22Z
dc.identifier.uri http://hdl.handle.net/11201/150687
dc.description.abstract [eng] Background: Newborns diagnosed with craniofacial malformations or laryngeal and tracheal alterations may often need advanced airway-management for airway stabilization. Although fiberoptic bronchoscopy (FB) is currently the gold standard for difficult airway management, there is a scarcity of published data on the application of FB in newborns for intubation and controlled extubation (CE). Objectives: This study describes a case series where FB is used for intubation and/or extubation to manage newborns with difficult airway in either urgent procedures or scheduled ones. Methods: All FB were carried out on newborns with difficult airway in the neonatal unit over the period January 2005 to December 2018. Patient characteristics were collected from clinical reports, description of the technique from the procedure report. Results: 66 FBs were performed from a total of 40 newborns, a median age of 25 days and a weight of 3217 g. Eighteen were ex-premature babies (45%). Six (15%) had craniocervical malformations. 17 (25.7%) FBs were performed for tracheal intubation (TI), 6 in emergency situations, 34 (51.5%) for CE, and 15 (22.7%) for precise tube placement. Clearing of the airway was achieved in all cases and thus there were no failed TIs. In 32 cases (94.1%), CE was successfully performed. In 6 cases, withdrawal of the ET midprocedure was decided to postpone as 4 of these required extra treatment prior to renewed extubation attempt and 2 needed a tracheostomy. 2 patients required subsequent FB reintubation due to airway pathology. Complications during the procedure were mild desaturations (3%) and deep desaturations (7.5%). Conclusions: FB is very safe and highly useful when performing intubation in neonates with difficult airway but is essential during extubation to avoid any risk of failure with a potentially fatal outcome. Neonatal units of tertiary hospitals should provide equipment and training to manage these neonates. What is already known? A failed intubation or extubation can lead to cardiac arrest and anoxic brain damage and/or to death in a neonate. Fiberoptic bronchoscopy is recommended as the safest tool for neonates with difficult airway. However, there is little concrete data published in the current literature to support the recommendations. What is new: Fiberoptic bronchoscopy is an essential tool to avoid the risk of a failed extubation in neonates with difficult airway
dc.format application/pdf
dc.relation.isformatof Versió postprint del document publicat a: https://doi.org/10.1080/14767058.2019.1670801
dc.relation.ispartof Journal Of Maternal-Fetal & Neonatal Medicine, 2019, vol. 2019, p. 1-5
dc.title Utility of fiberoptic bronchoscopy for difficult airway in neonates
dc.type info:eu-repo/semantics/article
dc.type info:eu-repo/semantics/acceptedVersion
dc.date.updated 2020-01-23T09:49:22Z
dc.date.embargoEndDate info:eu-repo/date/embargoEnd/2026-12-31
dc.embargo 2026-12-31
dc.subject.keywords Fibroendoscopia
dc.subject.keywords neonat
dc.rights.accessRights info:eu-repo/semantics/embargoedAccess
dc.identifier.doi https://doi.org/10.1080/14767058.2019.1670801

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