# Respiratory Support and Airway Management — GCMD Library living collection Updated: n/a · 2 episodes · 24 cited statements ## Episodes ### Diaphragm Pacing - [Diaphragm pacing as alternative to mechanical ventilation in pediatric respiratory failure](https://library.globalcastmd.com/watch/diaphragm-pacing-as-alternative-to-mechanical-ventilation-in-pediatric-respirato-16838) — podcast · 1:44 · [machine version](https://library.globalcastmd.com/watch/diaphragm-pacing-as-alternative-to-mechanical-ventilation-in-pediatric-respirato-16838.md) ### Tracheomalacia - [Journal of Pediatric Surgery quarterly review: tracheobronchopexy outcomes, surgical outreach access, and gastrostomy practice variation](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871) — podcast · 16:35 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871.md) ## Chapters - [0:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=0) Tracheobronchopexy outcomes for severe airway collapse after esophageal atresia repair (Ep 2) - [4:11](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=251) Pediatric surgical outreach access and geographic barriers in Canada (Ep 2) - [10:22](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=622) Practice variation and quality improvement targets in pediatric gastrostomy tube placement (Ep 2) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - Most pediatric surgeons won't see 10 patients with postoperative airway collapse spells in their career, and many wouldn't see 5 — George W. Holcomb III (epidemiological) [Ep 2 · 2:21](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=141) - Dynamic bronchoscopy showed complete airway collapse in 90% of patients — George W. Holcomb III (clinical) [Ep 2 · 2:34](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=154) - Three-quarters of procedures used a posterior approach — George W. Holcomb III (clinical) [Ep 2 · 2:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=160) - Tracheobronchopexy was performed on thoracic trachea alone in over half the patients but had to extend onto the bronchi in 40% — George W. Holcomb III (clinical) [Ep 2 · 2:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=164) - 94% of patients avoided tracheostomy with a mortality rate of 5% — George W. Holcomb III (clinical) [Ep 2 · 2:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=177) - The procedure significantly reduced pressure ventilation and ventilator dependence — George W. Holcomb III (clinical) [Ep 2 · 2:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=177) - Canada is the second largest country in the world geographically but population-wise smaller than California (epidemiological) [Ep 2 · 5:28](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=328) - The majority of Canada's population lives within 200 kilometers of the US border (epidemiological) [Ep 2 · 5:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=338) - The study did not address surgical care provided to children in remote communities by non-pediatric surgical specialists (clinical) [Ep 2 · 7:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=435) - In most places in Canada, no one would transfer a 16 or 17 year old with appendicitis to a children's hospital for surgery as they are physiologically adult and do not need pediatric surgeon expertise (opinion) [Ep 2 · 7:36](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=456) - Access to surgical care for children in Canada has been in need of improvement for decades (opinion) [Ep 2 · 7:51](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=471) - It is a misconception that the Canadian healthcare system ensures timely care; children wait for surgery beyond their wait time target (clinical) [Ep 2 · 8:01](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=481) - Newfoundland and Labrador's population is really rural and spread out, and weather can make accessing care impossible or financially devastating (clinical) [Ep 2 · 8:31](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=511) - The study used RGIS geospatial mapping to identify distribution of outreach sites nationally across Canada (clinical) [Ep 2 · 8:50](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=530) - There are measurable costs of living remote to accessible high quality care in terms of time required to be seen and clinical outcomes (clinical) [Ep 2 · 9:01](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=541) - Gastrostomy tube insertion is one of the most common operations performed in pediatric surgery (epidemiological) [Ep 2 · 11:19](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=679) - Until now there wasn't a great national clinical sample of data capturing both care processes and outcomes specific to G tubes (clinical) [Ep 2 · 11:19](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=679) - The study used 71 NSQIP pediatric hospitals that participated in the G-tube pilot starting in 2023 (clinical) [Ep 2 · 11:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=707) - In the NSQIP database, 5% of all pediatric procedures were G tube — Sean Kunisaki (epidemiological) [Ep 2 · 11:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=716) - 77% of G tube cases were first-time G tubes as opposed to redos (epidemiological) [Ep 2 · 12:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=766) - The heterogeneity in use of preoperative upper GIs was extremely broad with no clear reason, indicating a potential teaching moment — Sean Kunisaki (opinion) [Ep 2 · 13:20](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=800) - An additional 5.5% of G tubes were dislodged in the 31 to 60 day period (clinical) [Ep 2 · 13:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=835) - Dislodgement rates are higher than readmissions or IR interventions, making them a great QI target (opinion) [Ep 2 · 13:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=835) - If you can get dislodgements down, ED visits go down; when early dislodgements happen patients are told to come back to the ED (clinical) [Ep 2 · 14:15](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=855) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - Esophageal atresia repair patients can experience severe airway collapse leaving them ventilator dependent or suffering repeated cyanotic spells — Em Gootee summarizing the discussion [Ep 2 · 1:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=101) - The series included 80 children who underwent tracheobronchopexy from two high volume centers, most with type C esophageal atresia — Em Gootee summarizing the discussion [Ep 2 · 2:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=128) - These results reflect expertise of centers who have done numerous or hundreds of these type procedures — Em Gootee summarizing the discussion [Ep 2 · 3:09](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=189) - In the Canadian context, outreach is defined as pediatric surgery service provided outside the main pediatric surgery tertiary center, not necessarily tied to geographic distance — Em Gootee summarizing the discussion [Ep 2 · 5:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=355) - Outreach services were present in only 7 out of 10 provinces and only 8 out of 18 children's hospitals (44%) provided outreach services — Em Gootee summarizing the discussion [Ep 2 · 6:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=403) - A significant number of outreach services are located within 50 kilometers of a children's hospital, leaving vast regions without access — Em Gootee summarizing the discussion [Ep 2 · 6:57](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=417) - Many families must travel hundreds or even thousands of kilometers for basic procedures — Em Gootee summarizing the discussion [Ep 2 · 7:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=428) - Newfoundland and Labrador has the best outreach setup with only two pediatric surgeons but outreach clinics all over the province, serving as a model — Em Gootee summarizing the discussion [Ep 2 · 8:16](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=496) - The children's surgery team within the American College of Surgeons started collecting G tube specific variables through NSQIP — Em Gootee summarizing the discussion [Ep 2 · 11:35](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=695) - The study analyzed 4,612 G tube placements from one year of data in 2023 — Em Gootee summarizing the discussion [Ep 2 · 12:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=758) - Upper GI studies were obtained in 45% of first-time G tube cases with interhospital variability from 0 to 99% — Em Gootee summarizing the discussion [Ep 2 · 13:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=784) - 14% of G tube cases resulted in an ED visit within 0 to 30 days — Em Gootee summarizing the discussion [Ep 2 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=825) - 5.2% of G tube cases involved dislodgement within 0 to 30 days — Em Gootee summarizing the discussion [Ep 2 · 13:45](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=825) - Quality improvement interventions include mechanical barriers to dislodgement, education, standardizing care preoperatively/intraoperatively/postoperatively, and ensuring language concordant care — Em Gootee summarizing the discussion [Ep 2 · 14:32](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=872) - Quality improvement is possible in the G tube space and these variables are good targets because you can actually do something about them — Em Gootee summarizing the discussion [Ep 2 · 14:48](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-quarterly-review-tracheobronchopexy-outcomes-surgic-16871?t=888) --- Educational content from recorded physician discussions — not medical advice. 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