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Association between length of intubation and subglottic stenosis in children

Denise Manica1, Cláudia Schweiger, Paulo José Cauduro Maróstica

  • 1Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil. denisemanica@gmail.com.

The Laryngoscope
|February 5, 2013
PubMed

Insights

Longer intubation and increased sedation in children undergoing mechanical ventilation are linked to a higher risk of developing subglottic stenosis (SGS). This study highlights key factors contributing to airway injury in pediatric intensive care.

Area of Science:

  • Pediatric critical care medicine
  • Otolaryngology
  • Respiratory medicine

Background:

  • Endotracheal intubation is a common procedure in pediatric intensive care units (PICUs).
  • Laryngeal lesions, including subglottic stenosis (SGS), are potential complications of endotracheal intubation in children.
  • Understanding risk factors is crucial for preventing airway morbidity.

Purpose of the Study:

  • To investigate the association between endotracheal intubation duration and other risk factors with laryngeal lesions in children.
  • To determine the incidence of subglottic stenosis (SGS) in this pediatric population.
  • To identify modifiable factors that may reduce the risk of SGS.

Main Methods:

  • Prospective study involving children aged 0 to <5 years requiring endotracheal intubation for over 24 hours.
  • Flexible fiber-optic laryngoscopy (FFL) performed post-extubation, with repeat FFL or laryngoscopy under general anesthesia if lesions persisted or symptoms developed.
  • Multivariate analysis to assess the impact of intubation length and sedation doses on SGS development.

Main Results:

  • 142 children were analyzed; 40.8% presented moderate to severe laryngeal lesions on initial FFL.
  • The incidence of subglottic stenosis (SGS) was 11.3% (95% CI, 7.1-17.5).
  • Each additional 5 days of intubation increased SGS risk by 50.3%; each additional sedation dose per day increased risk by 12%.

Conclusions:

  • This study reports a higher incidence of SGS in children compared to previous research.
  • The duration of endotracheal intubation and the number of sedation doses are significant risk factors for SGS development.
  • Findings emphasize the importance of minimizing intubation time and sedation in pediatric patients to prevent airway complications.
Abstract

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