Related Experiment Video
Updated: Jun 25, 2025
Author Spotlight: Advancing Awake Nasotracheal Intubation with Flexible Video Rhino-Laryngoscopes
Published on: August 2, 2024
Post-extubation laryngitis in children: diagnosis, management and follow-up
Elaine Costa1, Débora Bressan Pazinatto1, Luciahelena Prata Trevisan1
1Disciplina de Otorrinolaringologia Cabeça e Pescoço, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Brazil.
Insights
Post-extubation laryngitis is common in children requiring intubation. Severe laryngeal lesions correlate with poorer outcomes, including higher rates of extubation failure and need for tracheostomy.
Area of Science:
- Pediatric Otolaryngology
- Critical Care Medicine
- Respiratory Medicine
Background:
- Post-extubation laryngitis is a recognized complication following mechanical ventilation in children.
- Understanding its incidence, evolution, and impact on clinical outcomes is crucial for effective management.
Purpose of the Study:
- To determine the occurrence of post-extubation laryngitis in pediatric patients.
- To analyze the one-year progression of laryngeal lesions.
- To correlate the severity of laryngeal lesions with clinical outcomes.
Main Methods:
- Retrospective study of children (up to 13 years) diagnosed with post-extubation laryngitis via endoscopic examination.
- Inclusion criteria: confirmed diagnosis; Exclusion criteria: prior intubation history or airway abnormalities.
- Data collected: patient demographics, underlying diagnosis, laryngeal lesions, treatment, and 12-month outcomes.
Main Results:
- 38 cases of confirmed post-extubation laryngitis (86.4% of suspected). Mean age 13.24 months; 60.5% male.
- Moderate/severe laryngeal lesions (53%) associated with higher extubation failures (1.95 vs 0.72), increased need for tracheostomy (36.8%), and laryngeal stenosis (21%).
- Complete resolution observed in 58.6% of patients at follow-up.
Conclusions:
- Post-extubation laryngitis is a frequent diagnosis in children with extubation issues.
- Severity of laryngeal lesions predicts a less favorable one-year prognosis.
- Otolaryngological evaluation and structured follow-up are vital for optimal management.
Objectives:
To describe the occurrence of post-extubation laryngitis, analyze its one-year evolution, and correlate laryngeal lesions with clinical outcomes.
Methods:
Retrospective study including children up to 13 years old at a tertiary hospital between March 2020 and March 2022 with diagnosis of post-extubation laryngitis confirmed by endoscopic examination. Exclusion criteria were prior history of intubation or anatomical airway abnormalities. Medical records were reviewed to characterize patients, underlying diagnosis, laryngeal lesions, treatment, and outcomes at 12-month follow-up.
Results:
The study included 38 endoscopically confirmed post-extubation laryngitis cases, corresponding to 86.4% of suspected cases. The mean age was 13.24 months, and 60.5% were male. Acute respiratory failure was the leading cause of intubation. Initial treatment was clinical, and initial diagnosis was defined by nasopharynoglaryngoscopy and/or Microlaryngoscopy and Bronchoscopy (MLB) findings. Initial diagnostic MLB was performed in 65.7% of the patients. Approximately half (53%) of the patients exhibited moderate or severe laryngeal lesions. When compared to mild cases, these patients experienced a higher rate of extubation failures (mean of 1.95 vs. 0.72, p = 0.0013), underwent more endoscopic procedures, and faced worse outcomes, such as the increased need for tracheostomy (p = 0.0001) and the development of laryngeal stenosis (p = 0.0450). Tracheostomy was performed in 14 (36.8%) children. Patients undergoing tracheostomy presented more extubation failures and longer intubation periods. Eight (21%) developed laryngeal stenosis, and 17 (58.6%) had complete resolution on follow-up.
Conclusion:
Post-extubation laryngitis is a frequent diagnosis among patients with clinical symptoms or failed extubation. The severity of laryngeal lesions was linked to a less favorable prognosis observed at one-year follow-up. Otolaryngological evaluation, follow-up protocols, and increased access to therapeutic resources are essential to manage these children properly.
Level Of Evidence:
Level 4.
Related Concept Videos
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:26Tonsillitis II: Management
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
01:30Endoscopic Studies I: Bronchoscopy and Thoracoscopy
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include: