Retrospective evaluation of the outcomes of advanced airway management in intubated patients with brachycephalic obstructive airway syndrome: 52 cases (2010-2020).

Objectives: To identify prognosis, complication incidence and risk factors associated with the management of brachycephalic obstructive airway syndrome necessitating immediate intubation on presentation.

Materials and methods: Data from 52 medical records at a private referral practice were retrospectively analysed. Univariate analysis followed by multivariate analysis was used to identify associations between response variables (set as pneumonia, regurgitation, tracheostomy placement, days in hospital and survival to discharge) and various independent factors when able. P < 0.05 was considered statistically significant.

Results: Survival to discharge was 71% (37/52) and younger age was associated with survival to discharge. Complications were reported in 48% of cases. Increased length of time intubated was associated with increased risk of pneumonia. French Bulldogs developed regurgitation more frequently than other brachycephalic breeds. Emergency surgery was associated with the need for a temporary tracheostomy tube and development of pneumonia. The odds of having a temporary tracheostomy tube placed were 50% greater when surgery was performed during hospitalisation for a crisis.

Clinical significance: Emergency airway surgery is associated with increased complications (regurgitation, tracheostomy tube, pneumonia/pneumonitis, time in hospital) when a patient presents in acute brachycephalic obstructive airway crisis. Advanced airway management to allow for stabilisation of patients and reduction of oedema to occur may be warranted in the acute crisis period.