Post-Intubation Acute Laryngeal Injuries: Analysis of Predictive Factors of Poor Prognosis

The objective of this study was to review the endoscopic management of post-intubation acute laryngeal injuries in children, the outcome of these treatments, and the possible factors for a poor outcome.

The study included all pediatric patients aged 0-14 years with an endoscopic diagnosis of post-intubation acute laryngeal injuries, treated at the Hospital de Clínicas de Porto Alegre from January 2018 to December 2022. The endoscopic techniques used for the treatment of injuries were balloon laryngoplasty and reintubation with a smaller tube with antibiotic and corticosteroid ointment coating around the tube. Possible predictive factors for poor prognosis and the need for a tracheostomy were investigated by reviewing medical records.

Of the 59 patients included, 50 (84.74%) comprised the "success" group and 9 (15.25%) the "failure" group. Predictive factors for poor prognosis are: short time for symptoms returning between airway endoscopic interventions, number of reintubations with antibiotic and corticosteroid ointment, number of airway endoscopies with interventions, and number of total airway endoscopies. Furthermore, when evaluating lesion types found in airway endoscopy, severe glottic edema, subglottic edema, and posterior glottic stenosis were shown to be associated with a worse prognosis.

This is the first review in literature that adds reintubation with corticosteroid and antibiotic ointment coating around the tube to balloon laryngoplasty for the management of post-intubation acute laryngeal injuries. Almost 85% of our patients were managed with success with such approaches. Injuries such as generalized edema and posterior glottic stenosis were factors associated with a poor prognosis.