Post‐intubation subglottic stenosis in children: Analysis of clinical features and risk factors

Abstract

Background Subglottic stenosis (SGS) is a complication that develops after intubation and is characterized by respiratory distress. The aim was to evaluate patients with post‐intubation SGS and to discover the factors contributing to its development. Methods A total of 112 patients who had a history of intubation were included. The case group consisted of 50 patients with post‐extubation persistent respiratory symptoms for which flexible bronchoscopy (FOB) was conducted and showed SGS. The control group consisted of 62 patient with no post‐extubation persistent respiratory symptoms, for whom FOB was not done (n = 54), and who had post‐extubation persistent respiratory symptoms and underwent FOB, which did not show subglottic stenosis (n = 8). Results No significant differences were detected related to age, gender, and gestational age. The median number of recurrent intubations was 2.5 and 3 in the case group and in control group, respectively (P = 0.14). The median duration of intubation was 20.5 days in the case group, and 6 days in the control group (P < 0.001). The Myer–Cotton classification indicated a degree of obstruction of grade 1 (mild) in 30% (n = 15), grade 2 in 16% (n = 8), grade 3 in 48% (n = 24), and grade 4 in 6% (n = 3) of the case group. Conclusion The duration of intubation was found to be a significant risk factor for SGS development. Age at intubation, gender, gestational age, indication of intubation, and the number of recurrent intubations were found to have no significant association. Patients with post‐extubation persistent respiratory problems, especially those with prolonged intubations, should be evaluated for SGS.

Glottic and Subglottic Injury and Development of Pediatric Airway Stenosis

“…This steady reduction of cases is likely due to streamlining of preventative measures and optimized treatment options in the critical care setting 20 . In the modern intensive care unit, conditions that decrease the integrity of airway mucosa, such as upper airway infection, poor nutritional status, anemia, and GERD, can be preemptively managed to avoid exacerbation of ETT‐induced trauma 13,20,23 . Current preventative measures consist of close monitoring for signs of infection, systemic corticosteroids, aerosolized racemic epinephrine and steroid therapy, and proton pump inhibitors 20,23 …”

“…Duration of endotracheal intubation and appropriate sizing of ETTs are considered the most salient predictors of acquired airway injury, but progression to stenosis depends on the complex interplay of each patient's comorbidities. 7,10,12,13 The primary objectives of this study were to report how often children with postintubation glottic or subglottic injury go on to develop airway stenosis and to identify clinical risk factors that may be contributory to pathogenesis.…”

Estimations of Laryngotracheal Stenosis After Mechanical Ventilation: A Cross‐Sectional Analysis

“…Previous research has consistently shown that pediatric age is an important risk factor. 20,21 Female sex is also an important risk factor, although studies of surgical treatment often contain equal groups. 3,15,17,18,22 Other risk factors that have inconsistently been shown to increase risk are obesity and GERD.…”

“…Although intubation is the insult that leads to airway stenosis, the capacity to develop stenosis is more common in certain groups. Previous research has consistently shown that pediatric age is an important risk factor 20,21 . Female sex is also an important risk factor, although studies of surgical treatment often contain equal groups 3,15,17,18,22 .…”

Post-intubation subglottic stenosis: aetiology at the cellular and molecular level

“…In addition, multiple studies have demonstrated that the risk of PI-SGS increases with the duration of intubation. Length of intubation is frequently considered to be the most relevant risk factor for the development of PI-SGS in both adults and children [10][11][12]. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated COVID-19 pandemic has led to an unprecedented increase in critically ill patients requiring prolonged mechanical ventilation [13].…”