Tu-be or Not Tu-be? Is routine endotracheal intubation necessary for successful bedside reduction and primary closure of gastroschisis?
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Read the article on jpedsurg.org ↗Article · Jul 2021 · 1 min read
In brief
In brief
This propensity-matched study challenges routine intubation for bedside gastroschisis closure, finding no significant difference in primary repair success rates while intubated patients required 3 additional ventilator days. The evidence supports attempting primary closure without intubation in stable neonates, potentially reducing mechanical ventilation exposure.
Written by the GCMD Library team from the article.
Background
Wide practice variation exists in the management of gastroschisis. Routine endotracheal intubation for bedside closure may lead to longer duration of mechanical ventilation.
Methods
The Canadian Association of Pediatric Surgery Network gastroschisis dataset was queried for all patients undergoing attempted bedside reduction and closure. Patients with evidence of intestinal necrosis or perforation were excluded. A propensity score analysis was used to compare the rate of successful primary repair and post-operative outcomes between intubated and non-intubated patients.
Results
In propensity score matched analysis, the successful primary repair rate did not reach statistical significance between patients who were intubated for attempted bedside closure and those who were not intubated (Odds Ratio: 2.18, 95% Confidence Interval: 0.79, 6.03). Intubated patients experienced 3.02 more ventilator days than patients who were not intubated at the time of initial attempted closure. Other post-operative parameters were similar between both groups.
Conclusions
It is reasonable to attempt primary bedside gastroschisis closure without intubation in otherwise healthy infants.