Laryngeal trauma with and without tracheal separation

Kahue, Charissa N.; Gelbard, Alexander

doi:10.1016/j.otot.2017.08.009

Cited by 3 publications

(3 citation statements)

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“…4,8,12,16 Each mL of CPD contains 3 mg ciprofloxacin and 1 mg dexamethasone; one drop contains 0.04 mg ciprofloxacin and 0.11 mg dexamethasone. 5 Anecdotal success of nebulized CPD has been reported for airway foreign body retrieval 13 , laryngeal trauma management 14 , tracheoplasty and tracheal resection 8 , and endoscopic airway management in children. 4,16 Notably, in our survey, a significantly greater percentage of respondents practicing for <10 years use nebulized CPD compared to those practicing for >10 years.…”

Section: Discussionmentioning

confidence: 99%

“…While there is limited literature on off‐label CPD use, the few studies that have investigated its utility are consistent with the findings of our survey. Much of the literature surrounding off‐label CPD use is in the setting of airway surgery including reconstruction, tracheal trauma management, endoscopic procedures, and bronchoscopic procedures such as foreign body removal with proximal bronchoplasty 4,8,12–14 . A 25‐year retrospective review study at Lurie Children's Hospital in Chicago, IL compared outcomes for patients who underwent slide tracheoplasty or tracheal resection before ( n = 20) and after ( n = 21) the initiation of routine post‐operative administration of off‐label nebulized CPD in 2007 8 .…”

Section: Discussionmentioning

confidence: 99%

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Assessing National Trends and Perceived Safety of Off‐Label Ciprofloxacin‐Dexamethasone Use by Pediatric Otolaryngologists

Shah,

Lockwood

et al. 2023

The Laryngoscope

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ObjectivesOff‐label use of Ciprodex® (ciprofloxacin‐dexamethasone: CPD), an antibiotic‐steroid combination solution, in the airway has been reported by pediatric otolaryngologists with anecdotal success. We examined national trends regarding off‐label CPD use including prevalence, common indications, prescriber patterns, adverse events, and accessibility.Methods15‐item cross‐sectional survey was distributed to American Society of Pediatric Otolaryngology members from January–April 2022. Univariate analyses were performed to compare responses for users of off‐label CPD versus non‐users. Ease of access was compared across geographies and practice types using multivariate logistic regressions.ResultsOf the 163 complete responses (26.6% response rate), 156 (95.7%) reported using off‐label CPD. Most common indications for off‐label CPD were tracheal granulation (87.8%, n = 137) and choanal atresia (82.1%, n = 128). Ease of access was significantly increased in the Midwest (OR:18.79, 95%CI:3.63–1.24, p = 0.001) and West (OR:29.92, 95%CI:3.55–682.00, p = 0.006). Ease of access was significantly lower at tertiary referral centers (OR:0.11, 95%CI:0.01–0.64, p = 0.041) and private practices (OR:0.04, 95%CI:0.002–0.33, p = 0.009) compared to academic free‐standing children's hospitals. Two‐thirds of respondents reported feeling “Very Comfortable” with the safety profile of off‐label CPD; 99.4% (n = 156) felt that the benefits outweighed the risks of off‐label use. Seven respondents (4.5%) reported adverse events (e.g., local allergic reaction, cushingoid symptoms) from off‐label use.ConclusionsOur findings (26.6% response rate) suggest that off‐label CPD is commonly used by pediatric otolaryngologists, many of whom reported feeling that the benefits of off‐label CPD outweigh the risks. Our results establish a baseline for future efforts to assess the efficacy and safety of off‐label CPD and to improve its accessibility.Level of EvidenceV Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessing National Trends and Perceived Safety of Off‐Label Ciprofloxacin‐Dexamethasone Use by Pediatric Otolaryngologists

Shah,

Lockwood

et al. 2023

The Laryngoscope

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“…Once cervical tracheal rupture is diagnosed, airway reconstruction should be performed actively to ensure airway integrity and continuity. Moreover, if there is no asphyxia caused by active bleeding within 48 hours of cervical tracheal rupture, there is no severe pulmonary inflammation in the lung, which has a good surgical effect and can reduce complications such as late tracheal stenosis, atresia and disability caused by delayed diagnosis and treatment [11].…”

Section: Discussionmentioning

confidence: 99%

Anesthesia Management of Trachea Reconstruction in a Patient with Traumatic Neck Closed Tracheal Complete Rupture

Yang,

Chen,

2023

IJACM

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Closed cervical tracheal rupture caused by trauma is a rare clinical emergency severe disease. We report the anesthesia experience of a 37-year-old male patient undergoing emergency tracheal reconstruction surgery due to a traumatic neck closed tracheal complete rupture. The patient was conscious and hoarse when entering the operation room, complained of dyspnea during inspirations, maxillofacial neck swelling, obvious subcutaneous crepitus of neck by palpation, and limited mouth opening. Mallampati grade III, neck movement was limited due to pain, and difficulty in intubation was considered in combination with the patient's neck, chest computed tomography (CT) and airway evaluation. Failure of intubation after the administration of muscle relaxants may result in rapid difficulty in establishing a surgical airway. Intubation under the guidance of awake bronchoscopy may fail to reach the distal tracheal end, and may lead to increased airway injury and inability to maintain ventilation. In order to ensure the safety of patient, it was decided to explore the neck incision under local anesthesia, find the broken end of the trachea, insert the endotracheal tube at the distal end, and then perform general anesthesia to control the airway. Intraoperative vital signs were stable of the patient. After the operation, the tracheostomy tube was changed and transferred the patient to ICU for further treatment. Patients with cervical tracheal rupture, establishing airway under local anesthesia with preserve the patient's spontaneous breathing combined sedation is a selection of security technology.

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Complete Laryngotracheal Separation Secondary to Blunt Trauma: A Case Report

et al. 2022

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Complete laryngotracheal separation is a rare life-threatening trauma that may occur due to road traffic accidents. Unfortunately, this injury may be missed if emergency physicians were not aware of its possibility. We present a pediatric patient who had complete laryngotracheal separation and esophageal injury caused by strangulation with a headscarf while riding a four-wheeled motorcycle. The neck on external examination showed only a ligature mark without open wounds. The injury was identified while attempting tracheostomy as the patient had a decreased oxygen saturation and was aphonic. The patient underwent complete airway reconstruction and stenting as well as low tracheostomy with complete reconstruction and anastomosis of the esophagus. The patient was decannulated after a few weeks with the vocal cords in paramedian position and no aspiration. This case demonstrates that early prompt treatment can save the patient’s life and result in good functional outcomes.

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Laryngeal trauma with and without tracheal separation

Cited by 3 publications

References 50 publications

Assessing National Trends and Perceived Safety of Off‐Label Ciprofloxacin‐Dexamethasone Use by Pediatric Otolaryngologists

Assessing National Trends and Perceived Safety of Off‐Label Ciprofloxacin‐Dexamethasone Use by Pediatric Otolaryngologists

Anesthesia Management of Trachea Reconstruction in a Patient with Traumatic Neck Closed Tracheal Complete Rupture

Complete Laryngotracheal Separation Secondary to Blunt Trauma: A Case Report

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