Airway investigations in paediatric congenital heart disease: an exploration of current practice

<bold>Introduction</bold>: Congenital Heart Disease (CHD) is frequently comorbid with other pathology, with airway pathology associated with significant morbidity; mortality and sizeable human and health economic costs. <bold>Objectives:</bold> To identify instances of airway investigation (AI) in our centre, their common findings and impact on patient management. <bold>Methods:</bold> All children with CHD in our centre who had undergone AI in a six-year period were identified and their medical records retrieved. Reports from all AIs undertaken (micro-laryngoscopy & bronchoscopy (MLB); flexible bronchoscopy; fluoroscopic bronchography; CT bronchography and CT Angiography) in our centre were obtained and findings extracted. Subsequent notes were analysed to determine the impact of AI findings on clinical management. <bold>Results:</bold> 80 patients underwent a total of 209 AIs. Of these, 165 (79.0%) were endoscopic. Pathology was identified in 90.4% of AIs, with this rate differing between AIs – positive findings were identified in all combined MLB & flexible bronchoscopies but only 65.2% of CT Angiograms. A change in management occurred following 58.9% of AIs. Intervention was carried out during 26.1% of the endoscopic AIs. Tracheostomy formation followed 29.2% of flexible bronchoscopies and 13.5% of MLBs. Those with existing tracheostomy have a significantly lower rate of AIs resulting in a management change than those without (46.8% vs 62.9%) – p=0.033 (Χ²). <bold>Conclusion:</bold> High rates of pathology detection and subsequent treatment based on results indicate effective implementation of AIs in our centre. A heterogeneous cohort and small sample size makes informative, statistical analysis difficult and supports a call for multi-centre work.