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Laryngoscope. 2009 May;119(5):967-73. doi: 10.1002/lary.20212.

Management of oral feeding in children undergoing airway reconstruction.

Author information

1
Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA.

Abstract

OBJECTIVES:

To systematically evaluate perioperative management of oral feeding in children undergoing airway reconstruction.

STUDY DESIGN:

A retrospective chart review of all patients who underwent open airway reconstruction from February 1, 2006 through July 31, 2008 at a tertiary care children's hospital.

METHODS:

During the study period, a multidisciplinary protocol for perioperative management of alimentation was instituted. Swallowing function was evaluated pre- and postoperatively as part of a clinical management protocol.

RESULTS:

Fifty-one patients underwent 55 reconstructions. Forty-eight of the patients (94%) have been decannulated. Eighteen single-stage procedures were performed on patients who were considered oral feeders, and oral feeding was successfully completed for three patients while the endotracheal tube was in place. Twenty-two double-stage procedures were performed on patients who were considered oral feeders. Oral feeding was initiated while the stent was in place for 16 patients. Nine patients (56%) did not tolerate oral feeding with the stent in place, five of whom had evidence of gross aspiration. Thirty-four of the 40 patients (85%) who were considered oral feeders at the time of their reconstruction returned to their preoperative diet with minimal therapy from the speech pathology service 1.9 days (range, 0-8 days) following extubation or stent removal. Six patients (15%) had clinically significant dysphagia.

CONCLUSIONS:

Safe oral alimentation early in the postoperative period is possible with a rigorous multidisciplinary approach. To minimize complications, postoperative oral feeding should be initiated in conjunction with a speech pathologist.

PMID:
19358199
DOI:
10.1002/lary.20212
[Indexed for MEDLINE]

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