[Subglottal stenosis following intubation in children]

Subglottal stenosis following intubation of children is infrequent, but significant. It is therefore necessary to know more about predisposing factors.

The files of all the 1,006 children who were intubated from 1982 to 1989 were studied. The following data were analysed: weight, height, locality of intubation, type and diameter of tube, reason for intubation, duration of intubation, delay and type of clinical signs of subglottal stenosis, treatment of this complication.

Twelve children (1.5%) developed subglottal stenosis; 9 were 5 months to 7 years old; the other 3 were neonates, 2 of them with a very low birth weight. The disease responsible for intubation was neurologic in origin in 6 cases, respiratory in 4 and hemodynamic in 2. The tube used for 4 children was too large, based on standards for age and weight. The mean duration of intubation was 21.1 days (1-129 days). Primary failure to extubate usually revealed subglottal stenosis, which was assessed by laryngoscopy. It was necessary to reinsert a tube for a mean duration of 20.2 days (4-41 days) in 11 of the 12 children; all patients received corticosteroids. 6 children required tracheostomy for 37 to 365 days. Dilation was necessary in 7 children. Finally, 9 children fully recovered, 1 has an asymptomatic persistent stenosis, 1 is still intubated with severe neurologic sequellae and 1 died accidentally, probably as a result of obstruction by tube dilation.

Stenosis remains a severe complication of intubation. The diameter of the tube is probably the most aggressive factor. It seems preferable to use a smaller, therefore cuffed tube and to secure the airways, if necessary, by inflating the cuff.