Airway complications in neonates who received mechanical ventilation

To determine the incidence, type and severity of airway complications in high risk neonates who received conventional mechanical ventilation.

Forty-five infants who had received conventional mechanical ventilation in the Neonatal Intensive Care Unit, Department of Pediatrics, Faculty of Medicine Siriraj Hospital for at least 4 days were enrolled. Orotracheal intubation with blue line, non-cuffed, non-shouldered polyvinylchloride tube was used exclusively. The average number of intubations was 2 (range 1-7), and the average duration for intubation was 25 days. The details of the intubation, and the presence of respiratory distress after extubation were recorded. All of the infants had endoscopic examination of the airway within 5 days of extubation.

Following extubation, 14 (31.1%) infants developed signs of upper airway obstruction, of which inspiratory dyspnea was the most common manifestation. Only 4 infants developed inspiratory stridor, three of them had a birth weight greater than 2,500 g. Abnormal bronchoscopic findings were found in 42 infants, 68.8 per cent had multiple sites of injury. Supraglottic lesions were found in 55.7 per cent of cases. Laryngomalacia was an associated finding in 8 and gastroesophageal reflux (GER) in 1 occasion.

From the result of this study, the authors found that airway complications related to endotracheal intubation are common among survivors from the Neonatal Intensive Care Unit. When the diagnosis of airway complications only depends on symptoms and signs of upper airway obstruction, the incidence and extent of injuries may be under-estimated. When attempted extubation fails or when VLBW infants develop increasing respiratory distress that is not clearly explained by an apparent disorder involving the pulmonary parenchyma, flexible bronchoscopic examination should be performed at the bedside with minimal risk.