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Endoscopic Screening for Laryngotracheal Complications in Children Following Prolonged Mechanical Ventilation
Mainak Dutta1, Debjit Jana2, Diptanshu Mukherjee2
1Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Kalyani; Basantapur, Saguna, Nadia, West Bengal, India.
Insights
Endoscopic screening of the pediatric upper airway after prolonged intubation can detect complications like subglottic stenosis. This follow-up is valuable even in asymptomatic children to identify potential issues from endotracheal tube use.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Critical Care Medicine
- Respiratory Medicine
Background:
- Prolonged mechanical ventilation via endotracheal tube (ET) in children can lead to upper airway complications.
- These complications may not always be symptomatic, necessitating proactive assessment.
- Endoscopic screening is proposed to evaluate the laryngotracheal airway post-extubation.
Purpose of the Study:
- To evaluate the effects of prolonged intubation on the pediatric laryngotracheal airway through endoscopic screening.
- To determine the incidence of airway complications in children after prolonged intubation.
- To assess the utility of routine endoscopic follow-up in this population.
Main Methods:
- A cross-sectional pilot study involving children aged 2 months to 12 years, extubated after prolonged intubation.
- Flexible nasolaryngoscopy was performed between 3 to 6 months post-extubation.
- Laryngotracheal airway changes were documented, irrespective of presenting symptoms.
Main Results:
- Out of 122 children, 42 developed symptoms. Screening identified complications in 40 symptomatic and 8 asymptomatic children (P<.0001).
- Common findings included subglottic stenosis (54%) and intubation granuloma (48%).
- A significant relationship was found between endotracheal tube type (cuffed/uncuffed) and airway complications (P<.0001).
Conclusions:
- Follow-up endoscopic screening of the upper airway is potentially useful in children after prolonged intubation.
- Prolonged intubation is significantly associated with upper airway complications, which may be asymptomatic.
- Routine screening can aid in early detection and management of post-intubation airway sequelae.
Background:
An endoscopic screening program following successful weaning from prolonged mechanical ventilation maintained through endotracheal tube (ET; prolonged intubation) may be justified to assess the upper (laryngotracheal) airway in children who may not always be symptomatic for intubation-related complications.
Objectives:
To evaluate effects of prolonged intubation in children through endoscopic screening of the laryngotracheal airway.
Methods:
In this cross-sectional pilot project, children (2 months-12 years) successfully extubated following prolonged intubation were selected, irrespective of having symptoms, for a 1-time flexible nasolaryngoscopy at third to sixth month post-extubation (follow-up window). Laryngotracheal airway changes, if present, were noted.
Results:
Out of 122 children, 42 developed symptoms of complications. Five of them attended within 3 months post-extubation, the rest were evaluated in the follow-up window. Eighty children aged ≤6 years and 4 children >6 years were intubated with uncuffed ET. Symptoms, when present, included respiratory distress (100%), noisy breathing (~36%), cough (~29%), and dysphagia (~12%). Screening revealed positive findings in 40 out of 42 symptomatic children, and in 8 out of 80 asymptomatic children (χ2 = 80.314; after Yate's correction; significant at P < .0001). The commonest lesion was subglottic stenosis (~54%) and intubation granuloma (~48%). Relationship between the nature of ET (cuffed/uncuffed) and complications of prolonged intubation was statistically significant (χ246.553; significant at P < .0001).
Conclusion:
The present study proposes the potential utility of follow-up endoscopic screening of upper (laryngotracheal) airway in children successfully weaned from prolonged intubation. A statistically significant relationship existed between prolonged intubation and upper airway complications that were not always symptomatic.
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