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Stridor is not a scientifically valid outcome measure for assessing airway injury

Josef Holzki1, Michael Laschat, Christian Puder

  • 1Department of Paediatric Anaesthesia, Children's Hospital Cologne, Beienburger Strasse 45, Roesrath, Germany. josef.holzki@arcor.de

Paediatric Anaesthesia
|July 4, 2009
PubMed

Insights

Cuffed endotracheal tubes are increasingly used in pediatric anesthesia, but studies often overlook severe airway injuries that don't cause immediate stridor. Endoscopic evaluation is crucial for accurately assessing and preventing intubation-related airway damage in children.

Area of Science:

  • Pediatric Anesthesiology
  • Otolaryngology
  • Pediatric Airway Management

Background:

  • Cuffed endotracheal tubes are increasingly utilized in pediatric anesthesia.
  • Previous studies comparing cuffed and uncuffed tubes primarily used post-extubation stridor as the main outcome.
  • These studies did not differentiate between minor edema and severe mucosal lesions, potentially underestimating airway injury.

Purpose of the Study:

  • To highlight the limitations of using stridor as the sole indicator of airway injury after pediatric intubation.
  • To emphasize the need for endoscopic assessment to detect all airway injuries, including silent lesions.
  • To call for studies employing endoscopic evaluation to guide the prevention of intubation-related airway injury.

Main Methods:

  • Review of existing literature on cuffed versus uncuffed intubation in pediatric anesthesia.
  • Analysis of outcome measures used in previous studies, particularly the reliance on stridor.
  • Discussion of clinical observations from pediatric endoscopists and ENT surgeons regarding airway injury detection.

Main Results:

  • Stridor may not accurately reflect the severity of airway injury, as significant lesions like ulcerations can be initially silent.
  • Delayed complications, such as stenosis, can arise from undetected mucosal injuries weeks or months post-intubation.
  • Endoscopic examination is the definitive method for identifying all types of airway injuries.

Conclusions:

  • Relying solely on stridor to assess airway injury after pediatric intubation is insufficient and potentially misleading.
  • Endoscopic evaluation is essential for accurate diagnosis and management of airway trauma in pediatric patients.
  • Further research incorporating endoscopic findings is urgently required to optimize intubation practices and minimize airway injury in children.

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