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Post-intubation subglottic stenosis: aetiology at the cellular and molecular level
Emma R Dorris1,2, John Russell3, Madeline Murphy4,2
1National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland emma.dorris@ucd.ie.
Summary
Subglottic stenosis (SGS) involves airway narrowing below the vocal cords, often due to scar tissue after intubation. This review explores how intubation triggers abnormal healing, causing breathing difficulties from fibrotic tissue buildup.
Area of Science:
- Respirology
- Pathology
- Surgical Complications
Background:
- Subglottic stenosis (SGS) is a narrowing of the airway below the vocal cords, characterized by fibrotic scar tissue.
- It can lead to significant breathing difficulties in both adults and children.
- Post-intubation SGS (PI-SGS) is a common cause, though its exact pathogenesis remains unclear.
Purpose of the Study:
- To review the pathogenesis of post-intubation subglottic stenosis.
- To explore how intubation alters the local micro-environment, promoting abnormal tissue repair.
- To identify key factors contributing to fibrotic tissue deposition in PI-SGS.
Main Methods:
- Literature review focusing on the pathophysiology of post-intubation subglottic stenosis.
- Analysis of mechanisms involving mucosal inflammation, hypoxia, and biomechanical stress.
- Synthesis of current understanding regarding abnormal healing processes in the subglottis.
Main Results:
- Intubation can induce changes in the airway's local micro-environment.
- Mucosal inflammation, local hypoxia, and biomechanical stress are implicated in PI-SGS development.
- These factors contribute to dysregulated tissue repair and excess fibrotic deposition.
Conclusions:
- Post-intubation subglottic stenosis results from an abnormal healing response initiated by intubation.
- Understanding the interplay of inflammation, hypoxia, and mechanical stress is crucial for managing PI-SGS.
- Further research into these mechanisms may lead to improved prevention and treatment strategies.
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