Position paper of diagnosis and treatment of post-extubation laryngitis in children: a multidisciplinary expert-based opinion.

Autor:	Pazinatto DB; Universidade Estadual de Campinas (UNICAMP), Hospital de Clínicas, Campinas, SP, Brazil. Electronic address: deborabpazinatto@gmail.com., Maunsell R; Universidade Estadual de Campinas (UNICAMP), Hospital de Clínicas, Campinas, SP, Brazil., Avelino MAG; Universidade Federal de Goiás, Hospital das Clínicas, Goiânia, GO, Brazil., Lubianca Neto JF; Hospital da Criança Santo Antônio, Porto Alegre, RS, Brazil., Schweiger C; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil., Caldas JPS; Universidade Estadual de Campinas (UNICAMP), Hospital da Mulher Prof. Dr. J. A. Pinotti-Caism, Campinas, SP, Brazil., Brandão MB; Universidade Estadual de Campinas (UNICAMP), Hospital de Clínicas, Campinas, SP, Brazil., Souza PP; Universidade Federal de Goiás, Hospital das Clínicas, Goiânia, GO, Brazil., Peixoto FAO; Universidade Federal de Goiás, Hospital das Clínicas, Goiânia, GO, Brazil., Ricachinevsky CP; Hospital da Criança Santo Antônio, Porto Alegre, RS, Brazil., Silveira RC; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil., Andreolio C; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil., Miura CS; Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Ribeirão Preto, SP, Brazil., Volpe DDSJ; Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Ribeirão Preto, SP, Brazil., Ferri WAG; Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Ribeirão Preto, SP, Brazil., Gavazzoni FB; Hospital Pequeno Príncipe, Curitiba, PR, Brazil., João PRD; Hospital Pequeno Príncipe, Curitiba, PR, Brazil., Possas SA; Hospital Pequeno Príncipe, Curitiba, PR, Brazil., Chone CT; Universidade Estadual de Campinas (UNICAMP), Hospital de Clínicas, Campinas, SP, Brazil.
Jazyk:	angličtina
Zdroj:	Brazilian journal of otorhinolaryngology [Braz J Otorhinolaryngol] 2024 May-Jun; Vol. 90 (3), pp. 101401. Date of Electronic Publication: 2024 Feb 22.
DOI:	10.1016/j.bjorl.2024.101401
Abstrakt:	Objectives: To make recommendations on the diagnosis and treatment of post-extubation laryngitis (PEL) in children with or without other comorbidities. Methods: A three-iterative modified Delphi method was applied. Specialists were recruited representing pediatric otolaryngologists, pediatric and neonatal intensivists. Questions and statements approached topics encompassing definition, diagnosis, endoscopic airway evaluation, risk factors, comorbidities, management, and follow-up. A consensus was defined as a supermajority >70%. Results: Stridor was considered the most frequent symptom and airway endoscopy was recommended for definitive diagnosis. Gastroesophageal reflux and previous history of intubation were considered risk factors. Specific length of intubation did not achieve a consensus as a risk factor. Systemic corticosteroids should be part of the medical treatment and dexamethasone was the drug of choice. No consensus was achieved regarding dosage of corticosteroids, although endoscopic findings help defining dosage and length of treatment. Non-invasive ventilation, laryngeal rest, and use of comfort sedation scales were recommended. Indications for microlaryngoscopy and bronchoscopy under anesthesia were symptoms progression or failure to improve after the first 72-h of medical treatment post-extubation, after two failed extubations, and/or suspicion of severe lesions on flexible fiberoptic laryngoscopy. Conclusions: Management of post-extubation laryngitis is challenging and can be facilitated by a multidisciplinary approach. Airway endoscopy is mandatory and impacts decision-making, although there is no consensus regarding dosage and length of treatment. (Copyright © 2024 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier España S.L.U. All rights reserved.)
Databáze:	MEDLINE
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