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Updated: Mar 8, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Undersedation is a risk factor for the development of subglottic stenosis in intubated children
Cláudia Schweiger1, Denise Manica1, Denise Rotta Rutkay Pereira2
1Hospital de Clínicas de Porto Alegre, Unidade de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
Insights
Children who developed subglottic stenosis after intubation were less sedated. Undersedation, indicated by higher COMFORT-B scores, was linked to increased risk of this airway complication.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Otolaryngology
Background:
- Subglottic stenosis (SGS) is a serious complication following endotracheal intubation in children.
- Sedation levels are crucial for patient comfort and management in the pediatric intensive care unit (PICU).
Purpose of the Study:
- To investigate the association between sedation levels and the development of subglottic stenosis in intubated children.
- To identify undersedation as a potential risk factor for SGS.
Main Methods:
- A prospective study included 36 children aged 30 days to 5 years requiring intubation in the PICU.
- Daily monitoring included COMFORT-B sedation scores.
- Flexible fiber-optic laryngoscopy and, if necessary, microlaryngoscopy were used to diagnose SGS.
Main Results:
- The incidence of subglottic stenosis was 11.1%.
- Children who developed SGS showed a significantly higher percentage of COMFORT-B scores indicating undersedation (23-30) compared to those without SGS (15.8% vs. 3.65%, p=0.004).
Conclusions:
- Lower sedation levels, evidenced by higher COMFORT-B scores, are associated with an increased risk of subglottic stenosis in intubated children.
- Optimizing sedation management may be a key strategy in preventing SGS.
Objective:
To analyze the level of sedation in intubated children as a risk factor for the development of subglottic stenosis.
Methods:
All patients between 30 days and 5 years of age who required endotracheal intubation in the pediatric intensive care unit between 2013 and 2014 were included in this prospective study. They were monitored daily and COMFORT-B scores were obtained. Flexible fiber-optic laryngoscopy was performed within eight hours of extubation, and repeated seven to ten days later if the first examination showed moderate to severe laryngeal injuries. If these lesions persisted and/or if the child developed symptoms in the follow-up period, microlaryngoscopy under general anesthesia was performed to evaluate for subglottic stenosis.
Results:
The study included 36 children. Incidence of subglottic stenosis was 11.1%. Children with subglottic stenosis had a higher percentage of COMFORT-B scores between 23 and 30 (undersedated) than those who did not develop subglottic stenosis (15.8% vs. 3.65%, p=0.004).
Conclusion:
Children who developed subglottic stenosis were less sedated than children who did not develop subglottic stenosis.
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