Iatrogenic damage to the pediatric airway Mechanisms and scar development

Holzki, Josef; Laschat, Michael; Puder, Christian

doi:10.1111/j.1460-9592.2009.03003.x

Cited by 46 publications

(43 citation statements)

References 13 publications

(18 reference statements)

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“…The neonatal subglottis is uniquely predisposed to postintubation mucosal edema and ischemia because of the friable subglottic mucosa and intraluminal constriction by the complete cricoid ring ( Figure 1) (2,3). Occult subglottic inflammation may manifest as airwaycompromising edema within minutes of extubation, often necessitating emergent reintubation.…”

mentioning

confidence: 99%

Long-Range Optical Coherence Tomography of the Neonatal Upper Airway for Early Diagnosis of Intubation-related Subglottic Injury

Sharma

Ahuja²,

Wiedmann

et al. 2015

Am J Respir Crit Care Med

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Rationale: Subglottic edema and acquired subglottic stenosis are potentially airway-compromising sequelae in neonates following endotracheal intubation. At present, no imaging modality is capable of in vivo diagnosis of subepithelial airway wall pathology as signs of intubation-related injury.Objectives: To use Fourier domain long-range optical coherence tomography (LR-OCT) to acquire micrometer-resolution images of the airway wall of intubated neonates in a neonatal intensive care unit setting and to analyze images for histopathology and airway wall thickness.Methods: LR-OCT of the neonatal laryngotracheal airway was performed a total of 94 times on 72 subjects (age, 1-175 d; total intubation, 1-104 d). LR-OCT images of the airway wall were analyzed in MATLAB. Medical records were reviewed retrospectively for extubation outcome. Measurements and Main Results:Backward stepwise regression analysis demonstrated a statistically significant association between log(duration of intubation) and both laryngeal (P , 0.001; multiple r 2 = 0.44) and subglottic (P , 0.001; multiple r 2 = 0.55) airway wall thickness. Subjects with positive histopathology on LR-OCT images had a higher likelihood of extubation failure (odds ratio, 5.9; P = 0.007). Longer intubation time was found to be significantly associated with extubation failure.Conclusions: LR-OCT allows for high-resolution evaluation and measurement of the airway wall in intubated neonates. Our data demonstrate a positive correlation between laryngeal and subglottic wall thickness and duration of intubation, suggestive of progressive soft tissue injury. LR-OCT may ultimately aid in the early diagnosis of postintubation subglottic injury and help reduce the incidences of failed extubation caused by subglottic edema or acquired subglottic stenosis in neonates.Clinical trial registered with www.clinicaltrials.gov (NCT 00544427).

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mentioning

confidence: 99%

Long-Range Optical Coherence Tomography of the Neonatal Upper Airway for Early Diagnosis of Intubation-related Subglottic Injury

Sharma

Ahuja²,

Wiedmann

et al. 2015

Am J Respir Crit Care Med

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“…• One enlightening review article, published in 2009, about the best use of different laryngoscope blades, reports about the most effective curvature at the tip of the blades, comes to similar results like the own group, based on observations, endoscopic investigations and a comprehensive review of the literature [7].…”

Section: Is Scientific Support Of Intubation Techniques Generally Posmentioning

confidence: 83%

“…However, to visualize the larynx below the vocal cords and the advancement of the tracheal tube beyond the glottis, a small Hopkins rod lens (Fig. 6.2) is necessary to document injuries or malformations in this area [7,8]. In case of suspecting an injury, the mucosa of the upper airway can be controlled during and immediately after extubation.…”

Section: Is Scientific Support Of Intubation Techniques Generally Posmentioning

confidence: 98%

“…Handhold with battery The endoscopic experience of decades of pediatric intubation of the author of this chapter and his group [7,8] has proven over the past 35 years that a curved blade with a pronounced bending of the tip (30-40°), placed into the vallecula, provides the best general view of the entrance of the larynx. This almost wide angled view offers a good chance for placing a tracheal tube through the larynx into the trachea of infants and children in the least traumatic way (see Fig.…”

Section: What Do We Really Know About Pediatric Intubation Technologymentioning

confidence: 99%

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Intubation of the Pediatric Patient

Holzki¹

2014

Airway Management

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Pediatric intubation is an often occurring practice in pediatric anesthesia. However, this does not mean this procedure to be entirely safe. Despite its long history there are still discussions going on whether the epiglottis should be uploaded with the tip of the blade of the laryngoscope or not. Endoscopic evidence has shown that this uploading can injure the mucosa significantly as well as narrow the entrance to the glottis, impeding the advance of tracheal tube which might injure the vocal cords particularly. With more frequent use of simple optical instruments the already high standard of safety in pediatric intubation could be improved.

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“…Iatrogenic causes of dysphonia, such as from endotracheal intubation, are also reported. But incidence figures prove difficult to calculate due to the varying nature of the underlying medical conditions and the treatments instituted [3]. …”

Section: Introductionmentioning

confidence: 99%

Dysphonia in Very Preterm Children: A Review of the Evidence

et al. 2014

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Introduction: Intubation is a known risk factor for dysphonia yet is essential in the perinatal care of many very preterm infants. Children born preterm, who are frequently resuscitated with endotracheal intubation, may be at risk of dysphonia at school age and beyond. Objectives: To identify and describe the evidence pertaining to long-term voice outcomes and risk factors for developing dysphonia in preterm children. Results: In addition to case studies and series, three larger-scale studies have reported on dysphonia and voice outcomes in preterm children. Studies reporting treatment outcomes were not available. Factors associated with poor voice outcomes included female gender, birth weight <1,000 g, birth at <27 weeks' gestation, surgical closure of patent ductus arteriosus, emergency versus elective intubations and multiple intubations. Adverse voice outcomes were associated with laryngeal pathology and compensatory supraglottic compression. Conclusions: Dysphonia is a newly reported, long-term complication of preterm birth, yet the number of relevant studies remains limited. Further research is required to confirm the risk factors for developing dysphonia, which will inform future voice treatment studies.

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Iatrogenic damage to the pediatric airway Mechanisms and scar development

Cited by 46 publications

References 13 publications

Long-Range Optical Coherence Tomography of the Neonatal Upper Airway for Early Diagnosis of Intubation-related Subglottic Injury

Long-Range Optical Coherence Tomography of the Neonatal Upper Airway for Early Diagnosis of Intubation-related Subglottic Injury

Intubation of the Pediatric Patient

Dysphonia in Very Preterm Children: A Review of the Evidence

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