Vocal cord dysfunction after pediatric cardiac surgery: A prospective implementation study

Kenny, Louise; McIntosh, Amy L.; Jardine, Karen; Suna, Jessica; Versluis, Kathryn; Slee, Nicola; Lloyd, Gareth; Justo, Robert; Merlo, Greg; Wilson, Mary; Reddan, Tristan; Powell, Jennifer; Venugopal, Prem; Betts, Kim; Alphonso, Nelson

doi:10.1016/j.xjon.2022.06.003

Cited by 8 publications

(19 citation statements)

References 29 publications

(73 reference statements)

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“…9 The reported procedure group closest to our cohort which included hypoplastic aortic arch repair via median sternotomy using cardiopulmonary bypass including Norwood procedure had a rate similar (13/23 = 57%) to that found in our study. 9 Similarly, other previous studies involving cohorts of repair of hypoplastic aortic arch as an isolated or combined procedure report incidences ranging from 48%-59%. 4,13 Other studies with lower overall incidence are largely retrospective with investigation of only symptomatic patients and do not involve standardized screening, resulting in potential under-estimation of incidence.…”

Section: Discussionsupporting

confidence: 80%

“…7,8 The Norwood procedure and aortic arch reconstruction have been previously described as high risk for injury to the RLN. 9 As operative survival for these patients has improved, it has become increasingly important to examine postoperative outcomes that contribute to morbidity. 3 Postoperative aspiration and feeding intolerance have been associated with prolonged hospital stay and other adverse respiratory sequelae.…”

Section: Introductionmentioning

confidence: 99%

“…3 Postoperative aspiration and feeding intolerance have been associated with prolonged hospital stay and other adverse respiratory sequelae. 9 Aspiration in this population, particularly in patients with single ventricle physiology, can have significant morbidity and mortality given the poor underlying endurance and respiratory reserve. 10 Therefore, postoperative vocal fold evaluation can be critical in diagnosing asymptomatic VFMI and silent aspiration as well as optimizing postoperative feeding management strategies and preventing further adverse sequelae.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound Screening After Cardiac Surgery Shows Vocal Fold Impairment and Predicts Aspiration

Siu,

Colyer,

Horner

et al. 2023

The Laryngoscope

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IntroductionVocal fold motion impairment (VFMI) is a known consequence after high‐risk cardiac surgery. We implemented a universal laryngeal ultrasound (LUS) screening protocol for VFMI after the Norwood and aortic arch surgery. We hypothesized that LUS would accurately identify VFMI and predict postoperative aspiration.MethodsWe implemented a screening algorithm with LUS for patients undergoing high‐risk cardiac surgery at a tertiary care pediatric hospital. Positively screened patients underwent flexible nasolaryngoscopy (FNL). Patients with an abnormal FNL underwent a video‐fluoroscopic swallow study (VFSS). Patient demographics, length of stay, and swallowing outcomes were assessed. Two‐tailed chi square and Wilcoxon rank sum tests were used to assess for differences.ResultsSixty‐seven patients underwent either Norwood or arch reconstruction over a 16‐month period and underwent universal LUS. The average birth weight was 3.24 kg (SD 0.57). Of the 67 patients, VFMI was identified by LUS and 100% confirmed on FNL in 58.21% (n = 39/67) of patients. Aspiration and penetration on VFSS were higher in the group with VFMI as compared with those without VFMI (53.8% vs. 21.4%, p = 0.008). There was no difference in length of stay between patients who did not have a diagnosis of VFMI and those found to have VFMI (41.0 days vs 45.3 days p = 0.73).ConclusionsUniversal LUS screening for patients following high‐risk cardiac surgery may lead to earlier identification of postoperative VFMI and aspiration. Recognition of VFMI through this universal screening program could lead to earlier interventions and possibly improved swallowing outcomes.Level of evidence3 Laryngoscope, 2023

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasound Screening After Cardiac Surgery Shows Vocal Fold Impairment and Predicts Aspiration

Siu,

Colyer,

Horner

et al. 2023

The Laryngoscope

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“…Postoperative VCD has been associated with increased postprocedure length of stay, costs, and likelihood of requiring an enteral tube at discharge, but it has not been shown to increase the duration of mechanical ventilation. 85,86 Long-term follow-up has demonstrated that patients with VCD are more likely to have a modified diet (ie, thickened feeds) at discharge and be at risk for readmission because of feeding difficulties or poor weight gain. 87 VCD has traditionally been diagnosed using fiberoptic examination performed by pediatric otolaryngologists, with aspiration subsequently diagnosed by a modified barium swallow examination.…”

Section: Vocal Cord Dysfunctionmentioning

confidence: 99%

“…The recurrent laryngeal nerve is prone to injury during cardiac surgery because of its proximity to the aortic arch and ligamentum arteriosus. Postoperative VCD has been associated with increased postprocedure length of stay, costs, and likelihood of requiring an enteral tube at discharge, but it has not been shown to increase the duration of mechanical ventilation 85,86 . Long‐term follow‐up has demonstrated that patients with VCD are more likely to have a modified diet (ie, thickened feeds) at discharge and be at risk for readmission because of feeding difficulties or poor weight gain 87 …”

Section: Nutrition Implementationmentioning

confidence: 99%

Nutrition for critically ill children with congenital heart disease

Kerstein,

Klepper,

Finnan

et al. 2023

Nut in Clin Prac

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Children with congenital heart disease often require admission to the cardiac intensive care unit at some point in their lives, either after elective surgical or catheter‐based procedures or during times of acute critical illness. Meeting both the macronutrient and micronutrient needs of children in the cardiac intensive care unit requires complex decision‐making when considering gastrointestinal perfusion, vasoactive support, and fluid balance goals. Although nutrition guidelines exist for critically ill children, these cannot always be extrapolated to children with congenital heart disease. Children with congenital heart disease may also suffer unique circumstances, such as chylothoraces, heart failure, and the need for mechanical circulatory support, which greatly impact nutrition delivery. Guidelines for neonates and children with heart disease continue to be developed. We provide a synthesized narrative review of current literature and considerations for nutrition evaluation and management of critically ill children with congenital heart disease.

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Clinical Prognosis of Vocal Cord Paralysis After Cardiothoracic Surgery in Infants

Masaki,

Tatewaki,

Kumae

et al. 2023

Pediatr Cardiol

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Vocal cord dysfunction after pediatric cardiac surgery: A prospective implementation study

Cited by 8 publications

References 29 publications

Ultrasound Screening After Cardiac Surgery Shows Vocal Fold Impairment and Predicts Aspiration

Ultrasound Screening After Cardiac Surgery Shows Vocal Fold Impairment and Predicts Aspiration

Nutrition for critically ill children with congenital heart disease

Clinical Prognosis of Vocal Cord Paralysis After Cardiothoracic Surgery in Infants

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