Infraglottic Edema and Subglottic Stenosis in Tracheostomy-Dependent Children: A Retrospective Cohort Study

Infraglottic edema secondary to swelling of the conus elasticus is a common observation in children after tracheostomy. We sought to describe the natural course of infra-glottic edema as seen at first direct laryngoscopy and bronchoscopy (DLB) and explore its association with developing subglottic stenosis (SGS) in tracheostomy-dependent children.

A retrospective cohort study of children who underwent tracheostomy between 2012 and 2022 in a tertiary care children's hospital.

A total of 255 children (mean age 3.5 ± 5.3 years) were enrolled, of whom 150 met inclusion criteria. Infraglottic edema was observed in 74 patients (49.3%) at first DLB, performed a median of 1.7 months after tracheostomy. Patients with edema were significantly younger at the time of tracheostomy and more likely to be ventilator-dependent due to bronchopulmonary dysplasia. Thirty patients (20%) developed SGS within 12-24 months of follow-up. On univariable analysis, factors associated with increased odds of developing SGS included the presence of infraglottic edema at first DLB, gestational age, age at tracheostomy, and medical comorbidities; no significant association between SGS and other variables was identified in multivariable analysis; however, the adjusted odds ratio suggested a 94% increase in odds of developing SGS in patients with infraglottic edema [OR 1.94, p = 0.16].

Infraglottic edema is a common early finding after pediatric tracheostomy. While none of the variables of interest were associated with the development of SGS, the comparatively higher odds of SGS in patients with infraglottic edema suggest a potential link that warrants further investigation in prospective studies.

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