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Glottic and Subglottic Injury and Development of Pediatric Airway Stenosis
Lauren A Pinzas1, Joshua R Bedwell2, Julina Ongkasuwan2
1Baylor College of Medicine, Houston, Texas, USA.
Insights
Pediatric patients with airway injury during tracheostomy are more likely to develop airway stenosis. Congenital heart disease increases injury risk, while younger age and prematurity are linked to stenosis progression.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Critical Care Medicine
- Pediatric Surgery
Background:
- Airway injury is a known complication following endotracheal intubation and tracheostomy in children.
- Identifying risk factors for airway stenosis is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of airway stenosis in pediatric patients with pre-existing airway injury at the time of tracheostomy.
- To identify risk factors associated with the development of airway stenosis in this population.
Main Methods:
- Retrospective review of a prospectively maintained database of 222 pediatric patients undergoing tracheostomy.
- Analysis of direct laryngoscopy findings at the time of tracheostomy and during follow-up.
- Statistical analysis including univariate and multivariate methods to assess risk factors.
Main Results:
- 46% of patients had evidence of airway injury at tracheostomy.
- Patients with airway injury were significantly more likely to develop stenosis (30% vs. 12%).
- Congenital cardiovascular disease was associated with increased risk of initial airway injury.
Conclusions:
- Pediatric patients with glottic or subglottic injury at tracheostomy have a higher likelihood of developing airway stenosis.
- While younger age, prematurity, and certain diagnoses were associated with stenosis, these did not reach significance in multivariate analysis for progression.
Objective:
To determine how often children with airway injury at the time of tracheostomy develop airway stenosis.
Study Design:
A 7-year retrospective review of a prospectively maintained database of pediatric patients who underwent endotracheal intubation followed by tracheostomy with concurrent and follow-up direct laryngoscopy.
Setting:
Tertiary care hospital.
Methods:
Outcomes included glottic or subglottic injury and progression to stenosis. Univariate and multivariate analyses were performed via SPSS.
Results:
Of the 222 patients (median age at surgery, 0.6 years; 54% male) who met study criteria, 46% had airway injury at the time of tracheostomy. Patients with congenital cardiovascular disease had 2.33-times increased risk of developing airway injury (P = .01). Patients with airway injury on initial direct laryngoscopy developed stenosis significantly more frequently than those without injury (30% vs 12%, P < .01). Risks factors for developing stenosis in children with airway injury include prematurity (P = .02), younger age at time of surgery (P < .01), endotracheal tube size (P < .01), Down syndrome (P = .03), and neonatal (P = .02) and/or congenital cardiovascular (P < .01) diagnosis. However, none of these variables were significant on multivariate analysis.
Conclusions:
Intubated patients with evidence of glottic or subglottic injury at the time of tracheotomy are more likely to develop airway stenosis than those without. Congenital heart disease was associated with twice the risk of developing airway injury, while progression to stenosis was associated with younger age, prematurity, and/or comorbid diagnoses.
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