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(Chest. 1999;116:260-263.)
© 1999 American College of Chest Physicians

Noninvasive Positive-Pressure Ventilation Facilitates Tracheal Extubation After Laryngotracheal Reconstruction in Children*

James H. Hertzog, MD; Linda B. Siegel, MD; Gabriel J. Hauser, MD, FCCP and Heidi J. Dalton, MD

* From the Department of Pediatrics (Drs. Hertzog, Hauser, and Dalton), Division of Pediatric Critical Care Medicine and Pulmonary Medicine, Georgetown University Medical Center, Washington, DC; and the Department of Pediatrics (Dr. Siegel), Division of Pediatric Pulmonary and Critical Care Medicine, Mount Sinai Medical Center, New York, NY.

Correspondence to: James H. Hertzog, MD, Division of Pediatric Critical Care Medicine and Pulmonary Medicine, CCC-5414, Georgetown University Medical Center, 3800 Reservoir Road NW, Washington, DC 20007-2197; e-mail: hertzogj{at}gunet.georgetown.edu

Tracheal extubation after laryngotracheal reconstruction in children may be complicated by postoperative tracheal edema and pulmonary dysfunction. The replacement of a tracheal tube in this situation may exacerbate the existing injury to the tracheal mucosa, complicating subsequent attempts at tracheal extubation. We present two cases where noninvasive positive-pressure ventilation was employed to treat partial airway obstruction and respiratory failure in two children following laryngotracheal reconstruction. Noninvasive positive-pressure ventilation served as a bridge between mechanical ventilation via a tracheal tube and spontaneous breathing, providing airway stenting and ventilatory support while tracheal edema and pulmonary dysfunction were resolved. Under appropriate conditions, noninvasive positive-pressure ventilation may be useful in the management of these patients.

Key Words: laryngotracheal reconstruction • noninvasive positive-pressure ventilation • pediatric intensive care






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Copyright © 1999 by the American College of Chest Physicians.