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Incidence of post-intubation subglottic stenosis in children: prospective study

Published online by Cambridge University Press:  28 February 2013

C Schweiger ,
P J Cauduro Marostica ,
M M Smith ,
D Manica ,
P R Antonacci Carvalho  and
G Kuhl
C Schweiger*
Affiliation:
Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
P J Cauduro Marostica
Affiliation:
Department of Paediatric Emergency, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Paediatric Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
M M Smith
Affiliation:
Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
D Manica
Affiliation:
Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
P R Antonacci Carvalho
Affiliation:
Paediatric Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil Paediatric Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
G Kuhl
Affiliation:
Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
*
Address for correspondence: Dr Claudia Schweiger, Ramiro Barcelos, 2350 Zona 19, 90035-903, Porto Alegre, RS, Brazil Fax: + 55 51 3359 8001 E-mail: causch@hotmail.com
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Abstract

Objective:

To evaluate the incidence of subglottic stenosis in children undergoing endotracheal intubation.

Methods:

Children in the paediatric intensive care unit of a tertiary care hospital were considered eligible for inclusion if they received endotracheal intubation for more than 24 hours. After extubation, children underwent flexible fibre-optic nasolaryngoscopy. Based on this first evaluation, they were divided into two groups: ‘acute normal’, with mild laryngeal alterations or normal findings; and ‘acute alterations’, with moderate to severe laryngeal alterations. Further laryngoscopic follow up (7–10 days later) was undertaken for those children in the acute normal group who developed symptoms during follow up (after discharge from the intensive care unit), and for all children in the acute alterations group. Children were then classified into two final groups: ‘normal final examination’, with no chronic changes; and ‘subglottic stenosis’.

Results:

We included 123 children. The incidence of subglottic stenosis was 11.38 per cent (95 per cent confidence interval, 6.63–17.94 per cent). All the children who developed subglottic stenosis had had moderate to severe alterations immediately after extubation.

Conclusion:

This incidence of subglottic stenosis is quite high and needs further investigation to identify risk factors.

Keywords

ChildAcquired Subglottic StenosisPrevalenceDiagnosis
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 4 , April 2013 , pp. 399 - 403
Copyright
Copyright © JLO (1984) Limited 2013

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References

1Stauffer, JL, Olson, DE, Petty, TL.Complications and consequences of endotracheal intubation and tracheotomy: a prospective study of 150 critically ill adult patients. Am J Med 1981;70:65–76CrossRefGoogle ScholarPubMed
2Tucker, GF, Ossoff, RH, Newman, AN, Holinger, LD.Histopathology of congenital subglottic stenosis. Laryngoscope 1979;89:866–77CrossRefGoogle ScholarPubMed
3Joshi, VV, Mandavia, SG, Stern, L, Wiglesworth, FW.Acute lesions induced by endotracheal intubation. Occurrence in the upper respiratory tract of newborn infants with respiratory distress syndrome. Am J Dis Child 1972;124:646–9CrossRefGoogle ScholarPubMed
4Parkin, JL, Stevens, MH, Jung, AL.Acquired and congenital subglottic stenosis in the infant. Ann Otol Rhinol Laryngol 1976;85:573–81CrossRefGoogle ScholarPubMed
5Strong, RM, Passy, V.Endotracheal intubation: complications in neonates. Arch Otolaryngol 1977;103:329–35CrossRefGoogle ScholarPubMed
6Jones, R, Bodnar, A, Roan, Y, Johnson, D.Subglottic stenosis in newborn intensive care unit graduates. Am J Dis Child 1981;135:367–8Google ScholarPubMed
7Papsidero, MJ, Pashley, NR.Acquired stenosis of the upper airway in neonates: an increasing problem. Ann Otol Rhinol Laryngol 1980;89:512–14CrossRefGoogle ScholarPubMed
8Contencin, P, Narcy, P.Size of endotracheal tube and neonatal acquired subglottic stenosis: Study Group for Neonatology and Paediatric Emergencies in the Parisian Area. Arch Otolaryngol Head Neck Surg 1993;119:815–19CrossRefGoogle Scholar
9Walner, DL, Loewen, MS, Kimura, RE.Neonatal subglottic stenosis – incidence and trends. Laryngoscope 2001;111:48–51CrossRefGoogle ScholarPubMed
10Dankle, SK, Schuller, DE, McClead, RE.Risk factors for neonatal acquired subglottic stenosis. Ann Otol Rhinol Laryngol 1986;95:626–30CrossRefGoogle ScholarPubMed
11Ratner, I, Whitfield, J.Acquired subglottic stenosis in the very-low birth weight infant. Am J Dis Child 1983;137:40–3Google ScholarPubMed
12Silva, O, Stevens, D.Complications of airway management in very-low birth weight infants. Biol Neonate 1999;75:40–5CrossRefGoogle ScholarPubMed
13Sherman, JM, Lowitt, S, Stephenson, C, Ironson, G.Factors influencing acquired subglottic stenosis in infants. J Pediatr 1986;109:322–7CrossRefGoogle ScholarPubMed
14Downing, GJ, Kilbride, HW.Evaluation of airway complication in high-risk preterm infants: application of flexible airway endoscopy. Paediatrics 1995;95:567–72CrossRefGoogle Scholar
15Jorgensen, J, Wei, JL, Sykes, KJ, Klem, SA, Weatherly, RA, Bruegger, DE et al. Incidence of and risk factors for airway complications following endotracheal intubation for bronchiolitis. Otolaryngol Head Neck Surg 2007;137:394–9CrossRefGoogle ScholarPubMed
16Cordeiro, AMG, Shin, SH, Fernandes, ICOF, Bousso, A, Troster, EJ.Incidence and endoscopic characteristics of airway injuries associated endotracheal intubation in children [in Portuguese]. Rev Assoc Med Bras 2004;50:87–92CrossRefGoogle ScholarPubMed
17Myer, CM 3rd, O'Connor, DM, Cotton, RT.Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994;103:319–23CrossRefGoogle ScholarPubMed
18Colice, GL.Resolution of laryngeal injury following translaryngeal intubation. Am Rev Respir Dis 1992;145:361–4CrossRefGoogle ScholarPubMed
19Smith, MM, Kuhl, G, Carvalho, PR, Marostica, PJ.Flexible fiber-optic laryngoscopy in the first hours after extubation for the evaluation of laryngeal lesions due to intubation in the paediatric intensive care unit. Int J Pediatr Otorhinolaryngol 2007;71:1423–8CrossRefGoogle Scholar
20Benjamin, B.Prolonged intubation injuries of the larynx: endoscopic diagnosis, classification, and treatment. Ann Otol Rhinol Laryngol Suppl 1993;160:1–15Google ScholarPubMed