Balloon dilatation for paediatric airway stenosis: Evidence from the UK Airway Intervention Registry

Abstract

Objectives:To assess the safety and efficacy in routine clinical practice of balloon dilatation procedures in the treatment of paediatric airway stenosis.Design: Observational data collection in prospective online research database.Setting: Acute NHS Trusts with ENT department undertaking complex paediatric airway work.Participants: Children (<18) undergoing balloon dilatation treatment for airway stenosis. Main outcome measures: Airway diameter, complications, hospital resource usage.Results: Fifty-nine patients had 133 balloon procedures during 128 visits to 10 hospitals. Sixty-nine (52%) of balloon procedures were conducted with a tracheostomy.Intra-operative Cotton-Myer grade decreased in 43 (57%). The mean pre-balloon subglottic diameter was 4.2 [95% CI: 3.8 to 4.5] mm, and its rate of increase was 0.8 [0.5 to 1.2] mm per year modelled on 30 patients' long-term data. As the primary treatment of stenosis, the procedural success rate of balloon dilatation (n = 52) was 65% (22% with tracheostomy, 88% without tracheostomy), and 71% as an adjunct to open reconstructive surgery (n = 7). In the 64 hospital visits where a balloon procedure was conducted with a tracheostomy in place, only one in-hospital complication (lower respiratory tract infection) occurred. For those without a tracheostomy in place, inhospital complications occurred in seven of 64 balloon hospital visits, all related to ongoing or worsening stenosis. Six out-of-hospital complications were deemed related to ongoing or worsening stenosis following the procedure, and two complications were a combination of lower respiratory infection and ongoing or worsening stenosis. Conclusions: Balloon dilation increases the size of the airway intraoperatively andis associated with long-term increase in airway diameter. Safety outcomes mostly relate to ongoing or worsening stenosis and are more common in patients without a tracheostomy.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

The ESTS-AIR database—initial results of a multi-institutional database on airway surgery

“…We are only aware of 2 other approaches. The Airway Intervention Registry (PI: Adam Sims, Newcastle upon Tyne) is a NHS initiative to enable a UK-wide data collection of ENT respiratory procedures conducted on children [ 10 ]. The database opened in 2015 and to the best of our knowledge, 2 projects have been pursued: the results of 59 children with airway stenosis treated by balloon dilatation has been published in 2019.…”

Myer‐Cotton Grade of Subglottic Stenosis Depends on Style of Endotracheal Tube Used

“…The authors noted that dimensions and derived percentages of obstruction were nearly identical across ETT manufacturers at the time, referencing Mallinckrodt and Portex Blue Line dimensions. Subsequent studies have found the Myer‐Cotton grade of stenosis to correlate with numerous outcomes, including pulmonary function testing and decannulation following open and endoscopic airway techniques 4‐9 …”

“…Subsequent studies have found the Myer-Cotton grade of stenosis to correlate with numerous outcomes, including pulmonary function testing and decannulation following open and endoscopic airway techniques. [4][5][6][7][8][9] Over the past three decades, many more ETT manufacturers have entered into the market, and advances in technology have allowed for changes in ETT dimensions. Propst et al found large differences in the dimensions and cuff location of four different cuffed ETT used in children and proposed a new strategy to prevent subglottic cuff placement and endobronchial intubation.…”