The role of the anterior cricoid split in facilitating extubation in infants.
OBJECTIVE
The use of the anterior cricoid split (ACS) procedure has facilitated the extubation of children with early subglottic stenosis who may otherwise have required a tracheostomy. Criteria have been established for the evaluation of patients suitable for ACS and adherence to these guidelines has increased the extubation rate and reduced mortality. The objective of the study was to assess the use of the procedure at our tertiary referral centre.


METHODS
In this retrospective clinical study, 33 patients were identified over an 11-year period between 1993 and 2004 with subglottic narrowing at the level of the cricoid ring, and who subsequently underwent an ACS. Demographic data, duration of intubation, indication and number of reintubations, success rate and complications were noted. Patients included in the study were infants who repeatedly failed trials of extubation and those who presented with persistent stridor.


RESULTS
Twenty-nine out of 33 (88%) children were successfully extubated as a result of the cricoid split procedure. Four children failed extubation after the cricoid split. Three required a tracheostomy and one child remained intubated for a prolonged period.


CONCLUSIONS
The anterior cricoid split procedure has revolutionised the management of early subglottic stenosis in selected neonates with failed extubation. It is a safe operation, and if successful it avoids the formation of a tracheostomy.
Eze
N N
NN
Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK. nnekaeze@yahoo.co.uk
Wyatt
M E
ME
Hartley
B E J
BE
D003413:Cricoid Cartilage / Q000601:surgery*; D020878:Device Removal / Q000379:methods*; D005260:Female; D005931:Glottis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007829:Laryngostenosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome