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Therapeutic reintubation for post-intubation laryngotracheal injury in preterm infants
L J Hoeve1, O Eskici, C D Verwoerd
1Department of Otorhinolaryngology, Sophia Children's Hospital, Erasmus University Rotterdam, The Netherlands.
Insights
Therapeutic reintubation is a successful treatment for preterm infants with prolonged intubation-induced laryngotracheal injury. This method offers a high success rate, often preceding surgical interventions.
Area of Science:
- Neonatal Medicine
- Pediatric Otolaryngology
- Critical Care
Background:
- Prolonged intubation in preterm infants can lead to laryngotracheal injury, hindering extubation.
- Current treatments include tracheotomy or anterior cricoid split, with reintubation as an alternative.
- Assessing the efficacy of reintubation is crucial for managing these injuries.
Purpose of the Study:
- To evaluate the therapeutic value of reintubation for post-intubation laryngotracheal injury in preterm infants.
- To compare reintubation outcomes with alternative surgical treatments like tracheotomy and anterior cricoid split.
Main Methods:
- Retrospective study of preterm infants in a neonatal intensive care unit.
- Classification of laryngotracheal injury into three categories based on laryngobronchoscopy findings.
- Analysis of therapeutic reintubation success rates and outcomes.
Main Results:
- Twenty-three preterm infants underwent therapeutic reintubation for a mean of 17 days.
- Reintubation therapy was successful in 22 out of 23 infants (95.7% success rate).
- Outcomes varied based on injury severity and patient condition, with a mean follow-up of 34 months.
Conclusions:
- Therapeutic reintubation is a highly effective treatment for post-intubation laryngotracheal injury in preterm infants.
- Reintubation should be considered a primary therapeutic option before resorting to surgical interventions.
- This approach offers a valuable, less invasive alternative for managing complex airway issues.
Abstract:
The failure to extubate a preterm infant after prolonged intubation is often caused by laryngotracheal injury. This condition is treated by tracheotomy, anterior cricoid split, or often, by reintubation and subsequent extubation attempts in a later stage. To assess the value of reintubation as treatment of post-intubation injury, we retrospectively studied a group of preterm infants from the neonatal intensive care unit in the Sophia Children's Hospital. Three categories of injury were distinguished according to the findings at laryngobronchoscopy: (a) edema or superficial lesions, (b) ulcerations and edema and (c) granulations. Twenty-three infants were therapeutically reintubated after post-intubation injury was diagnosed, for a mean period of 17 days. The therapy was successful in 22 patients, and a failure in one. The follow-up period was a mean 34 months. The result and the duration of the treatment vary with the category of the injury and the condition of the patient. Therapeutic reintubation is compared with alternatives such as anterior cricoid split and tracheotomy. We conclude that reintubation is a valuable therapy that should precede the decision for surgery.