Intubation Related Laryngeal Injuries in Pediatric Population

Abstract

Introduction: Laryngeal intubation related lesions (LIRL) in pediatric patients cause extreme morbidity in both elective and emergency settings. It has a wide range of presentations from minor laryngeal edema to a life-threatening airway obstruction. We report here our units' experience with LIRL in neonates, infants, and small children.Material and Methods: This is a retrospective monocentric cohort study between January 2013 and April 2019.Results: Thirty-nine patients with intubation lesions were included in the study. We looked at the lesions type, characteristics, management, and outcome. Half the patients were premature and having comorbidities. Main LIRL were subglottic stenosis (31%), ulcers (26%), granulations (18%), retention cysts (18%), posterior glottic stenosis (13%), and vocal cords edema (5%). Unfavorable lesions causing airway stenosis were associated with an intubation duration of over 1 week and were an important factor in causing airway stenosis (p < 0.05). The endoscopic treatment performed for these lesions was lesion and anatomical site-specific. Tracheostomy was needed in five patients, and was avoided in another two. Seven patients (18%) received open surgery prior to their decannulation.Conclusions: LIRL management is challenging and stressful in the pediatric population and optimal treatment could avoid extreme morbidity in them. Intubation duration and associated comorbidities are important factors in deciding the severity of these lesions. Protocols to prevent the formation of these lesions are critical.

Glottic and Subglottic Injury and Development of Pediatric Airway Stenosis

“…In the present study, 30% of children with glottic or subglottic injury vs 12% of children without airway injury on initial DL went on to develop airway stenosis. Given that 86% of all participants had at least 1 major comorbidity (Down syndrome, GERD, congenital cardiovascular syndrome, neonatal syndrome), our rates coincide with those reported in previous literature 7,12 . The presence of congenital cardiovascular disease was the only risk factor associated with significantly increased rates of initial injury on univariate analysis and was confirmed via multivariate logistic regression.…”

“…[10][11][12][13] The presence of patient-related comorbidities, such as cardiac malformations and genetic diagnoses, increased rates of stenosis from an average 11% to 30% on endoscopic examination. [9][10][11][12][13] Gestational age has also been inconsistently associated with formation of stenosis, with some studies showing no association and some showing higher rates with severe prematurity (23-24 weeks). 10,13 Children with airway stenosis exhibit stridor, recurrent respiratory infections, swallowing difficulties, and hoarseness, adding further morbidity to patients who are medically fragile at baseline.…”

Incidence of Laryngotracheal Lesions After Orotracheal Intubation in Coronavirus Disease Patients

“…The repair process begins in the basement membrane, with granulation tissue formation being gradually replaced by mature fibrotic scarring that is evident 3 to 4 weeks after extubation. [10][11][12][13] Patients with laryngotracheal stenosis have different clinical presentations, including dyspnea, stridor, dysphagia, cough, hemoptysis, and dysphonia. Hoarseness is the most common symptom in patients undergoing OTI, occurring in 14.4% to 50% of these cases.…”

Flexible Endoscopy With Non-invasive Ventilation Enables Clinicians to Assess and Manage Infants With Severe Bronchopulmonary Dysplasia

“…Since birth, they encounter frequent invasive trauma, such as intubations, suctions, infections, prolonged PPV, and systemic injuries of sepsis, hypoxia, and acidosis during their complicated and lengthy hospitalizations. These iatrogenic damages could result in AET tissue fibrosis, lumen narrowing, and structural weakness ( 23 – 25 ). Therefore, sBPD infants are best measured and managed by a multidisciplinary team that are specialized on comprehensive care of such diseases.…”