Prevention of subglottic stenosis in neonatal ventilation

Bacterial Colonization of Endotracheal Tubes in Intubated Neonates

“…7,8 In an effort to minimize friction trauma by tube motion, nasotracheal intubation has been supported and tube fixation devices have also been devised. 9 Attention has alternatively turned to the underlying cause of subglottic stenosis. The first step in the development of subglottic stenosis is mucosal ischemia induced by cuff or tube pressure.…”

Method of endotracheal tube fixation and iatrogenic ear deformities

“…4) were used, as is the usual practice of our NICU. Nasal ETTs, once in place, can be fixed rigidly to the baby's face which might reduce the incidence of subglottic stenosis [4]. Nasal intubation, however, has been suggested to be a risk factor for bacteraemia [1] and can lead to ulceration and excoriation of the nostrils.…”

“…Yet, in a retrospective review of the incidence of subglottic stenosis in the four metropolitan regions of London, no significant difference in the incidence of subglottic stenosis between NICUs which used straight or shouldered ETTs was noted (Rivers et al, unpublished data). Nevertheless, impaction of the shouldered part of the ETT onto the cricoid ring could lead to rapid pressure necrosis in the subglottic region [4,7]. Impaction of the ETT, however, can be avoided if the tip of the ETT is positioned at or above the level of the clavicles on the chest radiograph.…”

Survival and short-term respiratory outcomes of <750 g infants initially intubated with 2.0 mm vs. 2.5 mm endotracheal tubes

“…However, there is limited information in the literature either supporting or refuting the use of 2.0 mm ETT to provide gas exchange effective enough to support premature infants. A study by Laing regarding prevention of subglottic stenosis in neonatal ventilation used the following infant weight based ETT size recommendations: 2.0 mm ETT for all infants weighing <1.5 kg, 2.5 mm ETT for infants weighing 1.5–2.5 kg, and 3.0 mm ETT for infants weighing 2.5–3.0 kg [ 9 ]. Although these endotracheal tube size recommendations were not absolute, the authors reported achieving adequate ventilation in the majority of the 500 infants intubated in their study based on these recommendations.…”