Airway Anti-Inflammatory Medication Regimen for Pediatric Intensive Care Unit Patients

Sunday, September 29, 2024

10:00 AM – 10:06 AM EDT

Location: MBCC, 225

Disclosure(s):

Jaclyn Lee, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Christopher Naranjo, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Kalpnaben R. Patel, CCRP:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Christopher T. Wootten, MD, MMHC:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Chronically intubated patients are at risk for airway edema and inflammation, leading to many additional sequalae. We propose a novel medication regimen for treatment of airway inflammation in pediatric intensive care unit (ICU) patients.

Methods: Retrospective cohort study of pediatric ICU patients at a tertiary care center between January 2020 and December 2023. Patients who failed extubation attempts or to wean appropriately from oxygen, for whom the department of otolaryngology was consulted, were included. Airway edema or inflammation was diagnosed via operative direct laryngoscopy (DL), and if present, study patients were placed on an airway anti-inflammation regimen consisting of: macrolide antibiotic, H2-blocker or proton-pump inhibitor, H1-blocker, leukotriene receptor antagonist (if over six months old), and inhaled corticosteroid (nebulizers of ciprofloxacin and dexamethasone drops). These patients were compared to age and condition-matched controls from prior years that did not receive the regimen. Primary outcomes included ultimate airway status, airway findings on serial DLs, and medication side effects.

Results: A total of 200 patients were included, of which 115 were prescribed the airway medications. They were 45% female, median age 4.6 months (IQR 2.5 – 12.3 months). Ultimately, 28% were weaned to room air, 10% discharged on home oxygen, and 20% required a surgical airway (tracheostomy or airway reconstruction). Patients on the airway anti-inflammation regimen had visualized improvement in airway inflammation on subsequent DLs. In comparison to controls, patients receiving the airway regimen had a lower incidence of requiring surgical airway (20% vs 44%), with an adjusted odds ratio (OR) = 0.33 (p = .046). Further analysis is currently ongoing to evaluate overall survival and surgical-airway-free survival between treatment and control groups via Kaplan-Meier method.

Conclusions: The proposed medication regimen is a novel and effective treatment to reduce airway inflammation and associated risks in pediatric ICU patients, including reducing the need for surgical airway.

Presenting Author(s)

Jaclyn Lee, MD

Resident Physician
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Christopher Naranjo, BS

Medical Student
Vanderbilt University School of Medicine
Nashville, Tennessee, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
SE

Strong L. Erika, APRN-CPNP-PC/AC

Pediatric Otolaryngology-Head and Neck Surgery Inpatient/Outpatient Nurse Practitioner
Monroe Carell Jr. Children's Hospital at Vanderbilt
Franklin, TN, United States

Disclosure information not submitted.
Kalpnaben R. Patel, CCRP

Clin/Tran Research Coord III
Vanderbilt University Medical Center
Franklin, TN, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Christopher T. Wootten, MD, MMHC

Professor, Department of Otolaryngology--Head and Neck Surgery
Vanderbilt University Medical Center
Nashville, TN, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

AG

Alexander H. Gelbard, MD

Associate Professor
Vanderbilt University Medical Center
Nashville, TN, United States

Disclosure information not submitted.