ABSTRACT
Background: Following tracheal intubation, some children may develop stridor, which is an indication of an obstructive lesion in the airway, such as an ongoing laryngeal stenosis (LS). This review focuses on evaluation of stridor and possible endoscopic predictors of progression to LS and, once post-intubation acute lesions are established, therapeutic choices to manage this disorder in avoidance of tracheostomy. Tracheostomy, due to its inherent increased morbidity, mortality and influence on social stigma, should be viewed only as a last resort. In this article, available conservative and alternative therapies for ongoing LS are thoroughly reviewed. Methods: A systematic review concerning randomized clinical trials and prospective studies on treatment modalities for LS was performed. A search strategy was developed for MEDLINE comprising terms related to disease, intervention and population. Title and abstract from captured references were peer-reviewed for eligibility. Selected studies full-texts were peer-reviewed and the results were compiled in a structured and narrative review. Stridor evaluation and post-extubation acute lesion classification were studied. Treatments such as balloon dilation, rigid dilation, corticosteroid-coated small tube intubation, and corticosteroid nebulization were described and evidence supporting their usage was discussed.
ABSTRACT
Abstract Objective: To analyze the level of sedation in intubated children as a risk factor for the development of subglottic stenosis. Methods: All patients between 30 days and 5 years of age who required endotracheal intubation in the pediatric intensive care unit between 2013 and 2014 were included in this prospective study. They were monitored daily and COMFORT-B scores were obtained. Flexible fiber-optic laryngoscopy was performed within eight hours of extubation, and repeated seven to ten days later if the first examination showed moderate to severe laryngeal injuries. If these lesions persisted and/or if the child developed symptoms in the follow-up period, microlaryngoscopy under general anesthesia was performed to evaluate for subglottic stenosis. Results: The study included 36 children. Incidence of subglottic stenosis was 11.1%. Children with subglottic stenosis had a higher percentage of COMFORT-B scores between 23 and 30 (undersedated) than those who did not develop subglottic stenosis (15.8% vs. 3.65%, p = 0.004). Conclusion: Children who developed subglottic stenosis were less sedated than children who did not develop subglottic stenosis.
Resumo Objetivo: Analisar o nível de sedação em crianças intubadas como um fator de risco para o desenvolvimento de estenose subglótica (ES). Métodos: Todos os pacientes entre 30 dias e cinco anos que necessitaram de intubação endotraqueal na Unidade de Terapia Intensiva Pediátrica entre 2013 e 2014 foram incluídos neste estudo prospectivo. Eles foram monitorados diariamente e foram obtidos os escores da escala Comfort-B. Foi feita laringoscopia com tubo flexível de fibra óptica em oito horas da extubação e repetida 7-10 dias depois, caso o primeiro exame tivesse mostrado lesões laríngeas moderadas a graves. Caso essas lesões tivessem persistido e/ou caso a criança tivesse desenvolvido sintomas no período de acompanhamento, foi feita microlaringoscopia sob anestesia geral para avaliar a ES. Resultados: Incluímos 36 crianças. A incidência da ES foi de 11,1%. As crianças com ES apresentaram um maior percentual de escores da escala Comfort-B entre 23 e 30 (subsedados) que os que não desenvolveram ES (15,8% em comparação com 3,65%, p = 0,004). Conclusão: As crianças que desenvolveram ES foram menos sedadas do que as que não desenvolveram.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Laryngostenosis/etiology , Intubation, Intratracheal/adverse effects , Severity of Illness Index , Laryngostenosis/diagnosis , Prospective Studies , Risk Factors , Deep Sedation , Airway ExtubationABSTRACT
OBJECTIVE: To analyze the level of sedation in intubated children as a risk factor for the development of subglottic stenosis. METHODS: All patients between 30 days and 5 years of age who required endotracheal intubation in the pediatric intensive care unit between 2013 and 2014 were included in this prospective study. They were monitored daily and COMFORT-B scores were obtained. Flexible fiber-optic laryngoscopy was performed within eight hours of extubation, and repeated seven to ten days later if the first examination showed moderate to severe laryngeal injuries. If these lesions persisted and/or if the child developed symptoms in the follow-up period, microlaryngoscopy under general anesthesia was performed to evaluate for subglottic stenosis. RESULTS: The study included 36 children. Incidence of subglottic stenosis was 11.1%. Children with subglottic stenosis had a higher percentage of COMFORT-B scores between 23 and 30 (undersedated) than those who did not develop subglottic stenosis (15.8% vs. 3.65%, p=0.004). CONCLUSION: Children who developed subglottic stenosis were less sedated than children who did not develop subglottic stenosis.
Subject(s)
Intubation, Intratracheal/adverse effects , Laryngostenosis/etiology , Airway Extubation , Child, Preschool , Deep Sedation , Female , Humans , Infant , Infant, Newborn , Laryngostenosis/diagnosis , Male , Prospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
Introducción: La estenosis traqueal congénita (ETC) es una entidad clínica infrecuente, que se caracteriza por la presencia de anillos traqueales circulares completos, que determinan estrechez fija del lumen traqueal ocasionando dificultad respiratoria de grado variable. Objetivos: Comunicar 10 pacientes portadores de ETC, sus aspectos clinicos, morfológicos y alternativas en el tratamiento. Pacientes y Método: Se analizó retrospectivamente las formas de manifestación, exámenes diagnósticos y evolución de diez pacientes portadores de ETC diagnosticados entre los años 1998 y 2006. Resultados: Seis pacientes con síntomas respiratorios graves requirieron cirugía correctora de la traquea, uno falleció luego de un año, en el postoperatorio de una intervención cardiovascular. Cuatro pacientes con sintomatología respiratoria menor no requirieron corrección quirúrgica, uno falleció en el postoperatorio de una cirugía cardiaca. Conclusión: La ETC es una malformación potencialmente grave que requiere tratamiento quirúrgico en los pacientes sintomáticos con obstrucción severa de vía aérea. Los pacientes con síntomas leves pueden permanecer en control y no ser sometidos a cirugía correctora.
Congenital tracheal stenosis (CTS) constitutes an uncommon disease, characterized by the presence of complete tracheal rings that determine a fixed narrow tracheal lumen with different levels of respiratory distress. Objective: To expose 10 patients with CTS in relation to their morphological-clinical aspects and treatment alternatives. Method: Retrospective analysis of these patients diagnosed with CTS between 1998 and 2006, in terms of clinical evolution and diagnostic exams. Results: 6 patients with severe respiratory symptoms needed corrective tracheal surgery; one of them died one year later during cardiac surgery. 4 patients with mild respiratory symptoms did not require tracheal surgery; one of them died during cardiac surgery. Conclusion: CTS is a serious malformation that requires surgical treatment in those patients with severe airway obstruction. Patients with mild symptoms are observed closely without the need for surgery.