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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2000 June;66(6):467-71


language: Italian

Post-intubation subglottic stenosis in children. Risk-factors and prevention in pediatric intensive care

Meneghini L., Zadra N., Metrangolo S., Narne S., Giusti F.

Università degli Studi - Padova Istituto di Anestesia e Rianimazione


Background. Endotracheal intu­ba­tion (EI) may ­result in sig­nif­i­cant inju­ry to the lar­ynx and tra­chea; sub­glot­tic sten­o­sis is the ­most dan­ger­ous con­se­quence of ­this inju­ry in the pedi­at­ric age. It is ­well ­known ­that ­there are poten­tial ­risk fac­tors for ­post-intu­ba­tion sub­glot­tic sten­o­sis, and name­ly the under­ly­ing dis­ease requir­ing EI, the age and ­body ­weight at EI, the dura­tion and num­ber of EI, the ­absence of seda­tion and the occur­rence of infec­tious, hypo­ten­sive or hypox­ic ­events dur­ing the peri­od of EI and the trau­mat­ic EI. On the ­basis of our ­data an ­attempt is ­made to under­stand ­which fac­tors are ­more impor­tant in the path­o­gen­e­sis of ­this com­pli­ca­tion and wheth­er ­post-intu­ba­tion sub­glot­tic sten­o­sis is a pre­vent­able com­pli­ca­tion of EI in chil­dren.
Methods. The clin­i­cal ­records of 32 out of 35 chil­dren ­with ­post-intu­ba­tion sub­glot­tic sten­o­sis ­referred to our insti­tu­tion ­because of ­this com­pli­ca­tion in the peri­od 1990-1997 (8 ­years) ­have ­been exam­ined. Three chil­dren ­were exclud­ed ­from the ­study ­because of par­tial ­data. Our sur­gi­cal divi­sion is spe­cial­ized in the diag­no­sis and the man­age­ment of pedi­at­ric laryn­got­ra­cheal dis­eas­es. The diag­no­sis was con­firmed by vid­eo­la­ryn­got­ra­che­os­co­py ­under gen­er­al anes­the­sia and by com­pu­ter­ized tomog­ra­phy or mag­net­ic res­o­nance imag­ing in 10 chil­dren ­whose tra­cheal sten­o­sis was crit­i­cal. The ­degree of the sten­o­sis was deter­mined accord­ing to Cotton’s clas­sifi­ca­tion.
Results. The anal­y­sis of our ­data con­firms ­that ­post-intu­ba­tion sub­glot­tic sten­o­sis is a ­more fre­quent com­pli­ca­tion in ­infants and par­tic­u­lar­ly in low ­birth ­weight ­infants. It ­occurred ­after ­long last­ing EI, but ­after ­short last­ing EI too. Many of the chil­dren ­observed had ­their tra­chea intu­bat­ed sev­er­al ­times dur­ing ­their ill­ness and ­many EI ­were trau­mat­ic. Sedation dur­ing EI was ­only sel­dom ­took ­into ­account by pedi­at­ric inten­si­vists.
Conclusions. Prevention of ­post-intu­ba­tion sub­glot­tic sten­o­sis is pos­sible ­through a bet­ter man­age­ment of the EI and of the ­child ­with a tra­cheal ­tube. Sedation of intu­bat­ed chil­dren and ­skill in the EI tech­nique and in the ­tube ­size selec­tion are ­very impor­tant. Many intu­ba­tions can be avoid­ed ­with a bet­ter atten­tion to the ­tube fix­a­tion and to extu­ba­tion cri­te­ria. Some chil­dren at ­high ­risk for ­this com­pli­ca­tion can be iden­ti­fied.

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