Post-intubation Subglottic Stenosis in Children. Diagnosis, Treatment and Prevention of Moderate and Severe Stenosis

Rodríguez, Hugo; Cuestas, Giselle; Botto, Hugo; Cocciaglia, Alejandro; Nieto, Mary; Zanetta, Adrián

doi:10.1016/j.otoeng.2013.10.005

Cited by 22 publications

(23 citation statements)

References 15 publications

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“…Studies that investigated the risk factors affecting the development of SGS had identified prematurity as a serious risk factor but gender was stated to have no effect. The study of Rodriguez et al on 71 pediatric patients who developed post‐intubation SGS reported no difference among patients in terms of gender (40 male / 31 female) . Similarly, no significant difference was reported in regard to gender by Morita et al in 33 pediatric patients (16 male/17 female) .…”

Section: Discussionmentioning

confidence: 90%

“…Stamm et al reported a mean duration of intubation of 21 days (1–129 days) in patients with SGS . Similarly, Rodriguez et al found a median duration of intubation of 30 days (minimum 4 days, maximum 150 days) in 71 patients with SGS . Manica et al conducted a study on 16 patients who developed SGS and demonstrated that every 5 days’ increase in the duration of intubation increased the rate of SGS development by 50.3% .…”

Section: Discussionmentioning

confidence: 93%

“…The most common degree of stenosis is grade 3 according to the Myer–Cotton grading system. The study by Rodriguez et al of 71 pediatric patients with post‐intubation SGS indicated that 57 patients had grade 3 SGS . Similarly, the study by Morita et al, conducted on 33 pediatric patients, reported that 29 patients had grade 3 SGS .…”

Section: Discussionmentioning

confidence: 94%

“…Subglottic stenosis (SGS) is one of the most common causes of upper airway obstruction in childhood. It can be congenital or acquired and has a frequency between 0.6% and 11% …”

mentioning

confidence: 99%

“…Acquired SGS is a narrowing of the airway lumen at the subglottic area, which mostly develops secondary to intubation and can present with post‐extubation respiratory distress and stridor . Reviewing the literature, there are some studies that address follow‐up and surgical techniques in patients who have developed post‐intubation SGS.…”

mentioning

confidence: 99%

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

Çakır

Atabek

Çalım

et al. 2020

Pediatrics International

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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.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 94%

“…Subglottic stenosis (SGS) is one of the most common causes of upper airway obstruction in childhood. It can be congenital or acquired and has a frequency between 0.6% and 11% …”

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Çakır

Atabek

Çalım

et al. 2020

Pediatrics International

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Immediate extubation after single-stage laryngotracheal reconstruction for subglottic stenosis in children

Tang

Yang

Zhang

et al. 2023

Eur Arch Otorhinolaryngol

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Purpose To evaluate the feasibility and clarify the appropriate indications for extubation immediately after single-stage laryngotracheal reconstruction (SS-LTR) in pediatric subglottic stenosis (SGS). Methods A retrospective study was performed from July 2017 to July 2022. All patients underwent SS-LTR with anterior costal cartilage graft. Information such as demographics, comorbidities, history of intubation or tracheostomy, Classification and grading of airway stenosis, the operation-specific decannulation rate and overall decannulation rate were analyzed. Results Twenty-two patients with simple SGS were identified. The median age at SS-LTR was 19 months (IQR = 18.5 months). Fourteen patients (63.6%) were intubated prior to the presentation of symptoms. Fourteen patients (63.6%) required preoperative tracheostomy to maintain a secure airway. Eight patients (36.4%) had congenital SGS, 10 patients (45.5%) had acquired SGS, and 4 patients (18.2%) had mixed SGS. Three patients had Grade II stenosis. Nineteen patients had Grade III stenosis. Comorbidities were found in 10 patients (45.5%). Major comorbidities were pneumonia. Congenital airway anomalies were found in 6 patients (27.3%). After anesthesia, all 22 patients were successfully extubated and returned to the general ward. Twenty patients had a satisfactory airway after SS-LTR. Two patients required reintubation or tracheostomy after operation. Operation-specific decannulation rate was 90.9%. The overall decannulation rate is 100%. Conclusion SS-LTR with anterior costal cartilage graft is an effective method to treat simple SGS ranging from Grades I to III in children. Extubation immediately after surgery is safe and feasible.

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Balloon Laryngoplasty in Pediatric Population with Subglottic Stenosis: 5 Years Experience in King Abdulaziz University Hospital a Tertiary Center

Kurdi

Al-Khatib

Malas

et al. 2019

Indian J Otolaryngol Head Neck Surg

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We reviewed our experience with balloon laryngoplasty (BLP) as a primary management of SGS in a tertiary care center in Saudi Arabia. In this review, a total of 147 patients who underwent Laryngobronchoscopy were reviewed. Only 10 pediatric patients diagnosed with SGS who underwent BLP as primary treatment in the period from January 2012 to December 2017 were included. After obtaining ethical approval, included patients' charts were reviewed. Adult patients and those with airway anomalies other than SGS were excluded. This study describes the outcome of 25 episodes of BLP for the selected participants. Sixty percent of the participants were males. Participants' age ranged from 1 to 14 years (mean 6.4 years). Four participants had comorbidities other than SGS. Most patients required more than one episode of BLP (average 3 episodes). Mean hospital stay was 11.7 days. There was no difference in recurrence of symptoms between using laser or knife in subglottic tissue release (p = 0.182). Although recurrence of symptoms was seen in 56% of the patients, almost all patients (100%) became free of symptoms eventually. Patients with co-morbid diseases were more likely to be transferred to PICU post-operatively (p = 0.003). In the treatment of acquired SGS, BLP is an effective and relatively safe alternative to open airway surgery.

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Post-intubation Subglottic Stenosis in Children. Diagnosis, Treatment and Prevention of Moderate and Severe Stenosis

Cited by 22 publications

References 15 publications

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

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

Immediate extubation after single-stage laryngotracheal reconstruction for subglottic stenosis in children

Balloon Laryngoplasty in Pediatric Population with Subglottic Stenosis: 5 Years Experience in King Abdulaziz University Hospital a Tertiary Center

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