Continuous Positive Airway Pressure (CPAP) Pediatric Patients With Subglottic Stenosis Who Undergo Balloon Dilatation
Condition: Airway Complication of Anesthesia; Congenital Subglottic Stenosis
MeSH terms: Laryngostenosis; Constriction, Pathologic
Study type: Interventional

Summary: 
      Nasal continuous positive airway pressure (CPAP) acts as a 'pressure' bridge between
      spontaneous breathing and controlled mechanical ventilation. As a result, there is an
      increasing trend in the prophylactic use of nasal CPAP in pediatric patients following
      high-risk airway procedures to reduce postoperative airway complications. Still, there is no
      study published on the prophylactic use of balloon dilatation in children with tracheal
      stenosis.The study hypothesizes that implementing postoperative prophylactic CPAP in
      pediatric cases with subglottic stenosis undergoing balloon dilation may shorten recovery
      time and minimize airway complications.
    

Detailed description: 
      Acquired pediatric subglottic stenosis is reported to have a prevalence of 1-2% . This rate
      reaches 8.3% in different case series. Acquired pediatric subglottic stenosis is commonly
      attributed to prolonged intubation, whereas the etiology also involves a history of traumatic
      or difficult airway. Balloon dilation laryngoplasty is an efficient and safe technique for
      treating primary and secondary acquired laryngotracheal stenosis. It is successfully applied
      in these children. Airway surgery typically necessitates a deeper level of anesthesia to
      control airway reflexes and manage the fluctuations in hemodynamic parameters, which are
      characteristic of this surgery.

      Nevertheless, general anesthesia must be applied several times to patients due to the need
      for multiple balloon dilatations. At the same time, the procedure also necessitates coping
      with postoperative complications that may arise. Because alveolar collapse, which is related
      to general anesthesia, impairs gas exchange by creating a shunt effect, potentially
      increasing perioperative hypoxemic episodes, which in turn increases the risk for
      postoperative pulmonary complications. A recent retrospective analysis found that 40.6% of
      children who underwent balloon dilation experienced desaturation. Additionally, tracheotomy
      was required in 15.6% of cases, with an equal percentage needing tracheal intubation.

      Prophylactic CPAP in pediatric cases has been shown to improve oxygenation by reducing the
      alveolar-arterial oxygen difference after pediatric laparoscopic surgery. However, it has
      been proven that CPAP applied after pediatric cardiac surgery has favorable effects on peak
      expiratory flow.
    

Intervention name(s): CPAP group: postoperative CPAP support, non-CPAP group: oxygen 3 liters per minute (L/min) either via mask for those who were extubated or through a T-piece for those with a trash
Intervention type(s): Procedure
Intervention description(s): The effect of CPAP was prevent atelectasis after apnoeic ventilation during the procedure and to reduce post-procedural airway problems.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The study included a total of 81 pediatric patients who were 0 to 12 years of age, classified as II and III according to the American Society of Anesthesiologists (ASA), and who underwent elective subglottic balloon dilation under general anesthesia due to acquired or congenital subglottic stenosis.Patients were randomized into two groups through computer-generated randomization into two groups: Group non-CPAP (Control, n=41) and Group CPAP (n=40).During the postoperative period, the CPAP group received Fi02:0.6 and 8 to 12 mmHg of nasal CPAP, or CPAP was initiated through the tracheostomy cannula. The non-CPAP group received Fi02:0.6, and oxygen support was provided at a rate of 3 liters per minute (L/min) either via mask for those who were extubated or through a T-piece for those with a tracheostomy cannula.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: pediatric airway; subglottic stenosis; apne; CPAP