Effective treatment of post‐intubation subglottic stenosis in children with holmium laser therapy and cryotherapy via flexible bronchoscopy

Abstract

Importance Post‐intubation subglottic stenosis (SGS) in children can be life threatening. Definitive treatment varies and lacks a universally accepted approach. Objective We performed a prospective study to assess the safety and feasibility of holmium laser combined with cryotherapy delivered via flexible bronchoscopy for the treatment of post‐intubation SGS in children. Methods This study involved all patients with post‐intubation SGS seen at the Interventional Pulmonology Department of Beijing Children's Hospital between July 2014 and December 2016. Holmium laser treatment and cryotherapy was then performed under flexible bronchoscopy, whose parents refused to accept the alternative standard treatment of tracheotomy and balloon dilation under direct laryngoscopy. Results Sixteen patients with post‐intubation SGS were included in this study. Ages ranged from 2 months to 12.25 years old. According to the Cotton‐Myer grading system, three cases were Grade II, 12 cases were Grade III, and one case was Grade IV. According to the McCaffrey system, eight cases were Stage 1, two cases were Stage 2, and six cases were Stage 3. The average number of procedures was 4.88. Fifteen of the 16 patients achieved clinical cure. One patient achieved clinical improvement. The average treatment course duration was 55.31 days. No severe complications were seen. Post‐treatment clinical symptoms, endoscopic findings and quality of life showed marked improvement. Interpretation Our study supports the conclusion that holmium laser treatment combined with cryotherapy via flexible bronchoscopy appears to be a safe and feasible treatment for post‐intubation SGS in children.

Case report: Idiopathic subglottic stenosis in a girl; successful treatment with macrolides

“…Laser therapy in combination with e.g., mitomycin-C seems to be more effective ( 63 ). A trial of pediatric patients with post-intubation stenosis used a holmium laser plus cryotherapy with great success (cure in 15 of 16 children) ( 64 ).…”

A novel and promising addition to the treatment arsenal for post‐intubation subglottic stenosis: Holmium laser ablation and cryotherapy via flexible bronchoscopy

“…Those patients with preoperative tracheostomies underwent successful decannulation and no patients in the cohort required new tracheostomy placement. It is important to note that Dr. Jiao et al achieved successful outcomes on all 15 patients not lost to follow up, and 13 of the 15 had Myer‐Cotton grade III stenosis. This suggests that the holmium laser and cryotherapy is effective in even severe cases of subglottic stenosis, which in the past have demonstrated worse endoscopic outcomes than mild stenosis and were more likely to require tracheostomy placement .…”

“…Dr. Jiao et al from Beijing Children's Hospital present an impressive report on the novel use of a holmium laser and subsequent cryotherapy delivered via a flexible bronchoscopy as a treatment modality for post‐intubation acquired subglottic stenosis in children. Excellent outcomes were achieved in 16 consecutive patients with serial procedures, including clinical cure (defined as: resolution of respiratory symptoms, significant improvement in subglottic stenosis grade, and tracheotomy decannulation) in 15 of 16 patients.…”

Erratum

“…The informed consent statement was unclear for the article, ‘Effective treatment of post‐intubation subglottic stenosis in children with holmium laser therapy and cryotherapy via flexible bronchoscopy’ 2 . The statement should read:…”

“…1 The statement should read:The authors declare that this study was approved by the Ethics Committee of Shenzhen Children's Hospital.The informed consent statement was unclear for the article, 'Effective treatment of post-intubation subglottic stenosis in children with holmium laser therapy and cryotherapy via flexible bronchoscopy'. 2 The statement should read:The authors declare that consent to participate in this study and for publication was obtained from patients' parents/ guardians.An informed consent statement was omitted from the article, 'Clonal and drug resistance dynamics of methicillin-resistant Staphylococcus aureus in pediatric populations in China'. 3 The statement should read:This was a retrospective study that did not contain any individual patient's detailed data.…”