Respiratory viral panels and pediatric airway evaluation: The role of testing for upper respiratory infections to stratify perioperative risk
Respiratory viral panels and pediatric airway evaluation: The role of testing for upper respiratory infections to stratify perioperative risk
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DOI：
10.1016/j.ijporl.2020.110057
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发表时间：
2020-07-01
影响因子：
1.5
通讯作者：
Chiang, Tendy
中科院分区：
文献类型：
--
作者：
Niermeyer, Weston L.;Ball, Jessica;Chiang, Tendy
目的：因喘鸣和呼吸窘迫而入院的儿童是一个复杂的患者群体，需要耳鼻喉科医生决定何时使用直接喉镜和支气管镜（DLB）进行评估和干预。从历史上看，病毒性上呼吸道感染（URTI）的诊断可能会导致手术推迟，因为担心与急性疾病相关的围手术期并发症。呼吸道病毒检测（RVP）常用于确认近期或活动性病毒感染的存在，并可影响上呼吸道阻塞的鉴别诊断。本研究旨在探讨是否积极RVP测试与围手术期并发症和手术结果在儿科患者进行住院DLB。方法：132例儿科患者的遭遇进行了回顾性图表审查。病毒检测结果，DLB适应症，DLB的结果，围手术期并发症进行了compared.Results：60次（45.5%）涉及阳性RVP，72（54.5%）涉及阴性RVP。RVP阳性的患者术前气道结构性诊断的可能性较低（P = 0.0250），而有复发性上呼吸道感染史的可能性较高（P = 0.0464）。DLB最常见的原因是由于担心结构病理学而需要评估气道。在大多数情况下（77.3%）观察到解剖异常。1例（1.7%）RVP阳性和1例（1.4%）RVP阴性患者发生喉痉挛，2例（2.8%）RVP阴性患者需要重新插管。未观察到其他严重并发症。RVP结果与重大或轻微并发症的发生率之间没有相关性。结论：DLB用于复杂的住院儿童喘鸣和呼吸窘迫的管理手术干预后的重大围手术期并发症是罕见的。RVP阳性、RVP上鉴定的特异性病原体和URI症状的存在与围手术期并发症无关。
Objectives: Children admitted with stridor and respiratory distress comprise a complex patient group that requires the otolaryngologist to decide when to assess and intervene with direct laryngoscopy and bronchoscopy (DLB). Historically, the diagnosis of viral upper respiratory tract infection (URTI) can lead to postponement of surgery due to concerns of perioperative complications related to acute illness. Respiratory viral panels (RVP) are often used to confirm the presence of recent or active viral infection and can affect the differential diagnosis of upper airway obstruction. This study examined whether positive RVP testing is associated with perioperative complications and operative findings in pediatric patients undergoing inpatient DLB.Methods: A retrospective chart review of 132 pediatric patient encounters was performed. Viral testing results, DLB indication, DLB findings, and perioperative complications were compared.Results: Sixty encounters (45.5%) involved a positive RVP, and 72 (54.5%) involved a negative RVP. Those with positive RVP were less likely to have a preoperative structural airway diagnosis (P = .0250) and more likely to have a history of recurrent upper respiratory infections (P = .0464). The most common reason for DLB was the need to assess the airway due to concern for structural pathology. Anatomic abnormalities were seen in a majority of encounters (77.3%) Laryngospasm occurred in 1 (1.7%) RVP positive and 1 (1.4%) RVP negative encounter, and 2 (2.8%) RVP negative encounters required reintubation. No other major complications were observed. No association was noted between RVP results and incidence of major or minor complication.Conclusions: Major perioperative complications after surgical intervention with DLB for the management of complex, inpatient children with stridor and respiratory distress are rare. RVP positivity, specific pathogens identified on RVP, and presence of URI symptoms were not associated with perioperative complications.