Association between subglottic stenosis and endotracheal intubation in tracheostomized pediatric patients

Area of Science:

• Pediatric Otolaryngology
• Critical Care Medicine
• Pediatric Surgery

Background:

• Intubation duration is a primary risk factor for subglottic stenosis.
• Tracheostomy is often recommended for adults after 10-15 days of intubation.
• The optimal timing for tracheostomy in pediatric patients to prevent stenosis requires further investigation.

Purpose of the Study:

• To analyze the association between intubation duration and subglottic stenosis in pediatric patients.
• To determine if there is an optimal timing for tracheostomy to reduce stenosis incidence.
• To evaluate risk factors for stenosis development in intubated children.

Main Methods:

• Retrospective study of tracheostomized pediatric patients from 2014-2019.
• Analysis of endoscopic findings at the time of tracheostomy.
• Inclusion criteria focused on newborns and children with prior intubation.

Main Results:

• Tracheostomy was performed on 189 patients; 72 met inclusion criteria.
• The overall incidence of subglottic stenosis was 21%.
• Mean intubation time was significantly longer in patients with stenosis (30 days) compared to those without (19 days).
• Stenosis incidence increased with intubation duration, reaching 20% after one month.
• Infants under 6 months showed greater tolerance to prolonged intubation, with a median time to stenosis of 56 days versus 24 days for older children.

Conclusions:

• Long intubation periods in pediatric patients necessitate preventive measures against laryngotracheal injury.
• Early consideration of tracheostomy is recommended for pediatric patients with prolonged intubation.
• Age is a significant factor in tolerance to intubation duration, with younger infants requiring closer monitoring.