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Published on: May 15, 2009
A retrospective observational study of acquired subglottic stenosis using low-pressure, high-volume cuffed
David Greaney1, John Russell2, Ian Dawkins3
1Department of Pediatric Critical Care and Anaesthesia, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
Insights
Cuffed endotracheal tubes in critically ill children did not lead to acquired subglottic stenosis requiring surgery. This study found no increased risk of subglottic trauma with a policy of using high-volume, low-pressure cuffed endotracheal tubes.
Area of Science:
- Pediatric Critical Care Medicine
- Otolaryngology
- Respiratory Medicine
Background:
- Cuffed endotracheal tubes (ETTs) are used in neonates and critically ill children, but concerns exist regarding acquired subglottic stenosis.
- The incidence of subglottic stenosis with modern high-volume, low-pressure cuffed ETTs in this population is not well-described.
Purpose of the Study:
- To evaluate the safety and complication rates of cuffed ETTs in a pediatric critical care unit over a 5-year period.
- To determine the incidence of acquired subglottic stenosis associated with cuffed ETT use.
Main Methods:
- Defined clinically significant subglottic stenosis as microlaryngoscopy findings within 6 months of ventilation.
- Reviewed data from 5309 pediatric critical care unit admissions (2012-2017), including intubation history and surgical management.
- Matched patients against theater management system for microlaryngoscopy data.
Main Results:
- Of 5309 admissions, 23 children (0.68% of intubated patients) had significant ETT-related pathology.
- Eight patients developed acquired subglottic stenosis; all requiring major surgery were initially intubated with uncuffed tubes.
- No patient initially intubated with a cuffed ETT developed subglottic stenosis requiring surgical correction.
Conclusions:
- No cases of acquired subglottic stenosis requiring major surgical correction were linked to cuffed ETTs in this cohort.
- Implementing a policy for appropriate use and maintenance of low-pressure, high-volume cuffed ETTs was not associated with increased subglottic trauma.
Introduction:
The safety of cuffed endotracheal tubes in the neonatal and critically ill pediatric population continues to be questioned due to the theoretical risk of acquired subglottic stenosis. The incidence of acquired subglottic stenosis in the high-risk mixed surgical and medical critically ill pediatric cohort using high-volume, low-pressure cuffed endotracheal tube policy has not yet been described. The aim of our study was to describe and evaluate the use and complication rate of cuffed ETT's in our unit over a 5-year period.
Methods:
We defined clinically significant subglottic stenosis as a positive stenotic finding of endotracheal tube-related pathology on a microlaryngoscopy within 6 months of invasive ventilation. All patients admitted through our pediatric critical care unit from January 10, 2012 to January 25, 2017 were matched against our theater management system database for the same period. We reviewed all matching patients' baseline demographics, comorbidities, intubation/endotracheal tube history, and subsequent surgical management.
Results:
Of 5309 pediatric critical care unit admissions (61% ventilated) and 1251 microlaryngoscopies, 23 children had endoscopic findings of clinically significant endotracheal tube-related pathology, reflecting 0.68% of all intubated patients. Eight patients developed acquired subglottic stenosis. All those requiring major surgical correction were ex-premature neonates initially intubated with uncuffed tubes in an external neonatal intensive care. No patient initially intubated with a cuffed endotracheal tube developed subglottic stenosis requiring surgical correction.
Conclusion:
We report no single case of acquired subglottic stenosis in our cohort that required major surgical correction from a cuffed endotracheal tube during a 5-year period. The introduction of a policy of appropriate placement and maintenance of low-pressure, high-volume cuffed endotracheal tubes in the pediatric critical care unit was not associated with an increased rate of endotracheal tube-related subglottic trauma.
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