Therefore, this study was conducted to identify risk factors of PMV in infants undergoing MDO. Therefore, in the present study, a mechanical ventilation lasting longer than 6 days was defined as prolonged mechanical ventilation (PMV).Ĭurrently, risk factors and complications of prolonged mechanical ventilation are not well-studied and the optimal duration of intubation during early mandibular distraction osteogenesis activation is poorly understood. ( 14) reported that attempting extubation at least 5 days postoperatively may improve the likelihood of avoiding complication, and in syndromic patients, an attempt to extubate 6 days after post–MDO may be more appropriate. ( 13) found that a minimum of 5 days of mechanical ventilation is most prudent considering patient's age, history of preoperative upper airway obstruction, and known difficult intubation. The reported duration of postoperative mechanical ventilation varied greatly in different studies and lasted from 1 to 46 days ( 10– 14). Mechanical ventilation is an important adjuvant therapy following MDO, but some patients require prolonged mechanical ventilation, because distraction was not enough and spontaneous breathing had not recovered which may increase the risk of ventilator-associated pneumonia (VAP), prolong hospital stay, and increase mortality ( 9). In recent years, mandibular distraction osteogenesis (MDO) is increasingly used as a first-line surgical treatment of severe airway obstruction in patients with PRS ( 6– 8). Many infants with PRS suffer from tongue-based airway obstruction and feeding intolerance due to micrognathia and glossoptosis. The incidence of PRS varies from 1:5,000 to 1:85,000 across studies due to differences in study populations and diagnostic criteria ( 2– 5). It is often accompanied with cleft palate ( 1). Pierre Robin sequence (PRS) is a congenital disease characterized by micrognathia, glossoptosis, and upper airway obstruction. For others, extubation may be attempted within 6 days after MDO. Multivariate logistic regression analysis confirmed that the preoperative gonial angle and postoperative pulmonary infection were independent risk factors of prolonged mechanical ventilation (both P < 0.05).Ĭonclusions: Infants with PRS and smaller preoperative gonial angle or postoperative pulmonary infection may be more likely to undergo prolonged mechanical ventilation after MDO. Results: Univariate logistic regression analysis revealed that age, preoperative gonial angle, and postoperative pulmonary infection were associated with prolonged mechanical ventilation (all P < 0.05). t-test, Wilcoxon Sum Rank test or chi-squared test were performed to compare variables that might associate with prolonged mechanical ventilation between the two groups, and then, significant variables identified were included in the multivariate logistic regression model to identify independent variables. Of the 74 infants, 26 (35.1%) underwent prolonged mechanical ventilation, 48 (64.9%) did not. Methods: A total of 95 infants with PRS underwent MDO at Guangzhou Women and Children's Medical Center between 20, and the clinical records of 74 infants who met the selection criteria were analyzed. This retrospective study was carried out to identify perioperative risk factors of prolonged mechanical ventilation in infants undergoing MDO. However, the optimal duration of intubation during early mandibular distraction osteogenesis activation is poorly understood.
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