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Intensive care experience with sclerotherapy for cervicofacial lymphatic malformations

Objective: To describe a cohort of patients needing intensive care support after sclerotherapy for cervicofacial lymphatic malformations. Design: Retrospective review of case records of patients undergoing sclerotherapy between January 2004 and November 2006. Setting: A tertiary, university-affiliated, pediatric teaching hospital. Patients: Five patients needing admission to a pediatric intensive care unit (PICU) following sclerotherapy with OK432. Interventions: None. Measurements and Main Results: Five patients needed a total of 13 PICU admissions. Ages ranged from 4 months to 19 months. All patients had extensive lesions that involved the airways, mediastinum, or floor of the mouth, documented by magnetic resonance imaging. Nine admissions involved elective intubation and ventilation following sclerotherapy due to the extent of lesions. There were four urgent admissions to the PICU with respiratory distress ranging from 3 to 18 days after sclerotherapy. The mean duration of admission was 7 days (total 93 days, range 2–22 days). Total ventilated hours were 1656 hrs with a range of 16.5–370 hrs per admission. Multiple procedures, such as drainage of cysts and further sclerotherapy procedures, were performed before extubation on the PICU. Conclusions: Children with extensive disease and airway involvement need multiple PICU admissions. The potential for life-threatening respiratory embarrassment is unpredictable following sclerotherapy. Consideration should be given to performing further sclerotherapy while the patients are intubated in the PICU. The PICU provides a safe and secure environment for such procedures.