APAGBI Small Research Grant
The successful applicants for the APAGBI Small Research Grant were:
Principal Applicant
Dr Helen Hume-Smith
Consultant Anaesthetist, Department of Anaesthesia, Great Ormond St Hospital
Title
Endoscopic evaluation of the paediatric airway after prior prolonged (>24hrs)tracheal intubation
Amount
£23,091
Scientific Abstract
Traditionally uncuffed tracheal tubes have been used in children under the age of 8 years. Improvements in cuffed paediatric tracheal tube design have lead to increased use in children supported by studies showing no significant increase in post extubation stridor. To date, no systematic endoscopic airway investigation has been performed in children who have had previous prolonged tracheal intubation. This would provide absolute data, as oppose to clinical endpoints, on frequency and risk factors for airway injuries in children with a focus on use of cuffed and uncuffed tubes. We are the UK centre in this prospective, observational, multi-centre study. Children who have previously been intubated for more than 24hours who are attending for planned surgery that requires intubation will be recruited. After standard anaesthetic induction a rigid endoscope will be guided down the trachea immediately prior to intubation. Recordings will be evaluated by a panel of international airway experts blinded to patient history. Pathological endoscopic findings at the level of the larynx, trachea and carina will be typed and graded and a comparison made between cuffed and uncuffed tubes. Regression analysis will be performed to elucidate other risk factors for intubation injury.
Interim report from Dr H Hume-Smith (10 KB)
Principal Applicant
Dr Michael Macmahon
ST5 in Anaesthesia, Royal Hospital for Sick Children, Edinburgh
Title
A case-crossover study investigating alternations of the ECG baseline in ventilated children undergoing thoracoscopic surgery: a reliable indicator of pneumothorax?
Amount
£3,024
Scientific Abstract
Introduction:
In paediatric anaesthesia, a pneumothorax is a medical emergency. Although diagnosis should be straightforward, the precipitous situation and lack of physical access to the chest can preclude prompt recognition of the typical signs.
Methods: This study will investigate the relationship between the up and downward movement (swing) of the lead II ECG trace with respiration in the presence of a pneumothorax. The lead II ECG trace will be studied in a paediatric, thoracoscopic case series. These cases involve the creation of a pneumothorax and single lumen tracheal tube ventilation: a situation analogous to a pneumothorax under anaesthesia in a ventilated child.
Results: The ECG baseline will be studied to look for a significant swing in the presence of a pneumothorax. The study is a case-crossover design, using the ECG data from before the pneumothorax as the control group for the ECG trace during the pneumothorax. A paired t-test will be done to establish if this association is significant.
Discussion: A negative result would reduce the diagnostic significance of ECG baseline changes in this critical paediatric anaesthetic scenario. However, a significant relationship will provide a useful piece of information to aid the decision making process and expedite appropriate management.
This project has now been completed and the results published in Anaesthesia;
MacMahon, M. and McCormack, J. (2013), Electrocardiographic changes associated with intra-operative pneumothorax in children. Anaesthesia, 68: 980-981. doi: 10.1111/anae.12395
The authors would like to thank the APAGBI and the NIAA for funding this project.
