“Post intubation Laryngeal injuries in a pediatric intensive care unit of tertiary hospital in India: A Fibreoptic endoscopic study”

Bharti, Bhartendu; Syed, Kamran Asif; Ebenezer, Kala; Varghese, Ajoy Mathew; Kurien, Mary

doi:10.1016/j.ijporl.2016.03.025

Cited by 16 publications

(15 citation statements)

References 26 publications

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“…Although literature remains controversial, duration of intubation is considered to play a major role in the postextubation outcome of the patient [3,11], and our study also showed a trend towards significance in developing stridor after intubation for more than a week. One could consider whether children intubated for more than a week would benefit from the use of steroids before extubation.…”

Section: Discussionsupporting

confidence: 62%

“…Previous studies have shown that the majority of patients show some form of laryngeal injury after extubation, varying from mild edema to vocal fold immobility. However, most of these injuries go unnoticed and heal spontaneously with no or minimal consequences [3][4][5][6][7]. Infrequently, postextubation laryngeal lesions lead to a life-threatening laryngotracheal stenosis, which presents with typical signs of upper airway obstruction like chest retractions, dyspnea, and inspiratory stridor.…”

Section: Introductionmentioning

confidence: 99%

“…The factors age, gender, low gestational age, low birth weight, (congenital) narrow larynx, gastro-esophageal reflux, traumatic intubation, and inappropriate tube size are also considered to contribute to the development of laryngeal intubation injury. However, literature is ambiguous with differing results [3,[8][9][10][11][12][14][15][16][17][18]. Also, the use of a cuffed tube in children under the age of 8 years has been under debate due to the concerns for laryngeal injury leading to laryngotracheal stenosis.…”

Section: Introductionmentioning

confidence: 99%

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Post-extubation stridor after prolonged intubation in the pediatric intensive care unit (PICU): a prospective observational cohort study

Veder

Joosten

Schlink

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Prolonged endotracheal intubation may lead to laryngeal damage, with stridor being the most relevant clinical symptom. Our objective was to determine the incidence of post-extubation stridor and their clinical consequences in children within a tertiary referral center and to identify contributing factors. Methods 150 children, aged 0-16 years, intubated for more than 24 h were prospectively enrolled until discharge of the hospital. Potential relevant factors, thought to mediate the risk of laryngeal damage, were recorded and analyzed. Results The median duration of intubation was 4 days, ranging from 1 to 31 days. Stridor following extubation occurred in 28 patients (18.7%); 3 of them required reintubation due to respiratory distress and in 1 child stridor persisted for which a surgical intervention was necessary. In multivariate analyses, we found the following independent predictors of stridor: intubation on the scene, the use of cuffed tubes and lower age. Conclusion Despite a high incidence for post-extubation stridor, only few children need reintubation or surgical intervention as a result of post-extubation lesions. Intubation on the scene, the use of cuffed tubes and young age are associated with a significant increased risk of post-extubation stridor. Awareness of these factors gives the possibility to anticipate on the situation and to minimize laryngeal injury and its possible future consequences.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Post-extubation stridor after prolonged intubation in the pediatric intensive care unit (PICU): a prospective observational cohort study

Veder

Joosten

Schlink

et al. 2020

Eur Arch Otorhinolaryngol

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“…Our study detected 50% incidence of granulations and ulcerations of the glottis and subglottic area. Bharti et al [ 24 ] found 97% acute laryngeal injury in his population, of which 88% were significant. A meta-analysis included 29 studies by Brodsky et al [ 6 ] recorded that erythema, edema, ulcerations, and granulations had a frequency of 82%, 70%, 31%, and 27%, respectively.…”

Section: Discussionmentioning

confidence: 96%

“…Similarly, Lilienstein et al [ 28 ] in a large retrospective study showed a longer LOS in the stridor group of patients compared to the matched group. In the study of Barthi et al [ 24 ], only one patient had multiple attempts at intubation. This child developed left vocal fold palsy.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of laryngeal injuries in extubated critical pediatric patients

Algebaly

Mohsen

Naguib

et al. 2021

Egypt Pediatric Association Gaz

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Background The larynx in children is unique compared to adults. This makes the larynx more prone to trauma during intubation. Under sedation and frequent repositioning of the tube are recorded as risk factors for laryngeal injury. We examined the larynx of 40 critically ill children in the first 24 h after extubation to estimate the frequency and analyze the risk factors for laryngeal trauma using the classification system for acute laryngeal injury (CALI). Results The post-extubation stridor patients had a higher frequency of diagnosis of inborn errors of metabolism, longer duration of ventilation, longer hospital stay, moderate to severe involvement of glottic and subglottic area, frequent intubation attempts, and more than 60 s to intubate Regression analysis of the risk factors of severity of the injury has shown that development of ventilator-associated pneumonia carried the highest risk (OR 32.111 95% CI 5.660 to 182.176), followed by time elapsed till intubation in seconds (OR 11.836, 95% CI 2.889 to 48.490), number of intubation attempts (OR 10.8, CI 2.433 to 47.847), and development of pneumothorax (OR 10.231, 95% CI 1.12 to 93.3). Conclusion The incidence of intubation-related laryngeal trauma in pediatric ICU is high and varies widely from mild, non-symptomatic to moderate, and severe and could be predicted by any of the following: prolonged days of ventilation, pneumothorax, multiple tube changes, or difficult intubation.

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Intubation‐Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients

2021

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Objectives/Hypothesis We report a posterior laryngeal rating system and measures of voice disability in pediatric patients undergoing phonosurgery for vocal fold paralysis. Posterior glottic deficiency may account for persistent voice disability. Study Design Retrospective Study. Methods Retrospective analyses of 66 subjects with primary unilateral vocal fold paralysis were reviewed for the status of posterior glottis and voice disability (Pediatric Voice Handicap Index [pVHI]). Gestation age (GA), weight, and medical/surgical history were reviewed. The width, length, and depth of the larynx were analyzed to create a reproducible rating scale. Results Mean GA was 29 weeks, with an intubation history for all subjects, with 90% having a left vocal fold immobility. Cardiac surgery was performed in 92% of subjects. A progressive rating (type 0–3) Benjamin Defect Severity Scale (BDSS) was developed to rate the absence or presence of a posterior abnormality. BDSS‐2 and BDSS‐3 subjects were more likely to have low birth weight. Extremely preterm GA was more likely to be associated with BDSS‐1 (mild) or BDSS‐2. History of multiple and prolonged intubations were seen more frequently in BDSS‐2 or BDSS‐3. Post‐op pVHI reduced an average of 15 points for BDSS‐0 to BDSS‐2, but only 3 points for BDSS‐3. Post‐op pVHI matched normal values for preintervention dysphonic children. Conclusions The presence of a persistent breathy voice after intervention for unilateral vocal fold immobility is potentially associated with posterior glottic defects. Low birth weight with multiple/prolonged intubation is more likely to be present with higher‐grade BDs, whereas low GA is more likely to be associated with BDSS‐1 to BDSS‐2. Level of Evidence 4 Laryngoscope, 131:2550–2557, 2021

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“Post intubation Laryngeal injuries in a pediatric intensive care unit of tertiary hospital in India: A Fibreoptic endoscopic study”

Cited by 16 publications

References 26 publications

Post-extubation stridor after prolonged intubation in the pediatric intensive care unit (PICU): a prospective observational cohort study

Post-extubation stridor after prolonged intubation in the pediatric intensive care unit (PICU): a prospective observational cohort study

Risk factors of laryngeal injuries in extubated critical pediatric patients

Intubation‐Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients

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