Experience with iatrogenic laryngeal and tracheal stenoses

Area of Science:

• Pediatric Otolaryngology
• Respiratory Medicine
• Critical Care

Background:

• Subglottic and tracheal stenosis are serious complications following prolonged endotracheal intubation and mechanical ventilation in infants and children.
• The average age of affected patients in this series was 18 months, highlighting the vulnerability of the pediatric airway.

Purpose of the Study:

• To review the experience with subglottic and tracheal stenosis in pediatric patients.
• To determine safe durations for endotracheal intubation in different age groups.
• To evaluate the efficacy of various treatment modalities for airway stenosis.

Main Methods:

• Review of clinical data from 38 patients with subglottic stenosis and 2 with tracheal stenosis.
• Analysis of factors contributing to airway stenosis, including intubation duration and infection.
• Evaluation of treatment outcomes for serial endoscopic resection, dilation, and intralesional steroid injections.

Main Results:

• Endotracheal intubation is considered safe for infants up to 3-4 weeks.
• For patients over 6 months, intubation should not exceed 7 days, with shorter durations recommended if infection is present.
• Serial endoscopic resection, dilation, and intralesional steroids were effective in most patients within one year.

Conclusions:

• Prolonged endotracheal intubation is a significant risk factor for pediatric subglottic and tracheal stenosis.
• Careful consideration of intubation duration, especially in the presence of infection, is crucial to prevent airway complications.
• Minimally invasive treatments like endoscopic resection, dilation, and steroid injections offer effective management for airway stenosis in pediatric patients.