Volume 132, Issue 9 pp. 1861-1868

Original Reports

Noninvasive Respiratory Support as an Alternative to Tracheostomy in Severe Laryngomalacia

Elina Veroul MD,

Elina Veroul MD

Faculté de Médecine, Université de Paris, Paris, France

Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

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Alessandro Amaddeo MD, PhD,

Alessandro Amaddeo MD, PhD

Faculté de Médecine, Université de Paris, Paris, France

Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

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Nicolas Leboulanger MD, PhD,

Nicolas Leboulanger MD, PhD

orcid.org/0000-0003-3466-6903

Faculté de Médecine, Université de Paris, Paris, France

Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

Institut Mondor pour la Recherche Biomédicale, INSERM U955 Team 13, Creteil, France

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Matthieu Gelin MSc, PhD,

Matthieu Gelin MSc, PhD

Université de Paris, Human Immunology Pathophysiology Immunotherapy (HIPI), CytoMorpho Lab, INSERM CEA UMR976, Paris, France

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Françoise Denoyelle MD, PhD,

Françoise Denoyelle MD, PhD

Faculté de Médecine, Université de Paris, Paris, France

Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

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Briac Thierry MD,

Briac Thierry MD

orcid.org/0000-0002-1898-1906

Faculté de Médecine, Université de Paris, Paris, France

Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

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Brigitte Fauroux MD, PhD,

Brigitte Fauroux MD, PhD

orcid.org/0000-0001-6092-2662

Faculté de Médecine, Université de Paris, Paris, France

EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Université de Paris, Paris, France

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Romain Luscan MD,

Corresponding Author

Romain Luscan MD

[email protected]

orcid.org/0000-0003-1219-727X

Faculté de Médecine, Université de Paris, Paris, France

Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

Send correspondence to Romain Luscan, MD, Department of Pediatric Otolaryngology–Head and Neck Surgery, Hôpital Necker-EnfantsMalades, AP-HP, 149 rue de Sèvres – 75015 Paris, France. E-mail: [email protected]

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Elina Veroul MD,

Elina Veroul MD

Faculté de Médecine, Université de Paris, Paris, France

Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

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Alessandro Amaddeo MD, PhD,

Alessandro Amaddeo MD, PhD

Faculté de Médecine, Université de Paris, Paris, France

Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

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Nicolas Leboulanger MD, PhD,

Nicolas Leboulanger MD, PhD

orcid.org/0000-0003-3466-6903

Faculté de Médecine, Université de Paris, Paris, France

Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

Institut Mondor pour la Recherche Biomédicale, INSERM U955 Team 13, Creteil, France

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Matthieu Gelin MSc, PhD,

Matthieu Gelin MSc, PhD

Université de Paris, Human Immunology Pathophysiology Immunotherapy (HIPI), CytoMorpho Lab, INSERM CEA UMR976, Paris, France

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Françoise Denoyelle MD, PhD,

Françoise Denoyelle MD, PhD

Faculté de Médecine, Université de Paris, Paris, France

Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

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Briac Thierry MD,

Briac Thierry MD

orcid.org/0000-0002-1898-1906

Faculté de Médecine, Université de Paris, Paris, France

Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

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Brigitte Fauroux MD, PhD,

Brigitte Fauroux MD, PhD

orcid.org/0000-0001-6092-2662

Faculté de Médecine, Université de Paris, Paris, France

EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Université de Paris, Paris, France

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Romain Luscan MD,

Corresponding Author

Romain Luscan MD

[email protected]

orcid.org/0000-0003-1219-727X

Faculté de Médecine, Université de Paris, Paris, France

Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France

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First published: 29 October 2021

https://doi.org/10.1002/lary.29928

Citations: 1

Editor's Note: This Manuscript was accepted for publication on October 19, 2021.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Abstract

Objectives/Hypothesis

To analyze the role of noninvasive respiratory support (NRS) as an alternative to tracheostomy in the management of severe laryngomalacia.

Study Design

We conducted a monocentric retrospective study in a tertiary pediatric care center.

Methods

All children under the age of 3 years with severe laryngomalacia, treated between January 2014 and December 2019, were included. Patient demographics, medical history, nutrition, surgery, NRS, and outcome were reviewed. Predictors for NRS were analyzed.

Results

One hundred and eighty-eight patients were included. Mean age was 4 ± 5 months and mean weight was 4,925 ± 1,933 g. An endoscopic bilateral supraglottoplasty was performed in 183 (97%) patients and successful in 159 (87%). NRS was initiated in 29 (15%) patients at a mean age of 3 ± 2 months (1–11 months): 15 (52%) patients were treated with NRS after surgical failure, 9 (31%) were treated with NRS initiated prior to surgery because of abnormal overnight gas exchange, and 5 (17%) were treated exclusively with NRS due to comorbidities contraindicating an endoscopic procedure. NRS was successfully performed in all patients with a mean duration of 6 ± 11 months. No patient required a tracheostomy. Univariate analysis identified the following predictors of NRS: neonatal respiratory distress (P = .003), neurological comorbidity (P < .001), associated laryngeal abnormality (P < .001), cardiac surgery (P = .039), surgical endoscopic revision (P = .007), and nutritional support (P < .001).

Conclusion

NRS is a safe procedure, which may avoid a tracheostomy in severe laryngomalacia, in particular, in case of endoscopic surgery failure, respiratory failure before surgery, and/or severe co-morbidity.

Level of Evidence

3 Laryngoscope, 132:1861–1868, 2022

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Volume132, Issue9

September 2022

Pages 1861-1868

Noninvasive Respiratory Support as an Alternative to Tracheostomy in Severe Laryngomalacia

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusion

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Information

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Noninvasive Respiratory Support as an Alternative to Tracheostomy in Severe Laryngomalacia

Abstract

Objectives/Hypothesis

Study Design

Methods

Results

Conclusion

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

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