Necrotizing Tracheobronchitis in Intubated Newborns

Abstract

This report describes a newly recognized iatrogenic lesion in newborns that we have termed necrotizing tracheobronchitis (NTB). Although it is related to assisted ventilation, it is different from previously described tracheal lesions in that it is most severe distal to the tip of the endotracheal tube and manifests a characteristic basophilic necrosis of the tracheal mucosa. Sloughing of tracheal mucosa, which occurs in the later stages, can cause respiratory obstruction. The lesion occurs over a wide range of gestational ages and birth weights as well as ventilatory rates, pressures, and supplemental oxygen concentrations. The severity of the lesion is related to the duration of ventilation. We believe NTB to be related to airflow through the endotracheal tube rather than to the effects of the tube itself because the lesion is worst beyond the end of the tube and extends into the major bronchi. A grading system is presented.

Tracheostomy in Preterm Infants

“…Long-term endotracheal intubation has been associated with risks for airway damage, including laryngeal edema, granulation tissue formation, ulceration, anterior web, vocal cord paralysis, subglottic stenosis, tracheomalacia, necrotizing tracheobronchitis, subglottic cysts, tracheal perforation, tracheal stenosis, and other less serious lesions of the airway. 1,[22][23][24][25][26][27][28][29][30][31] With improved neonatal intensive care, the incidence of neonatal subglottic stenosis has progressively decreased during the past 25 years, from 0.9% to 8.3% in the period of 1971 to 1979 to 0.0% to 0.63% in the period of 1990 to 1999. 20 Only 11 (0.29%) of 3793 neonates in our institutions required a tracheostomy for subglottic stenosis.…”

Neonatal Necrotizing Tracheobronchitis: Three Case Reports

“…In other studies, cases of NTB are described but are not related to any specific mode of ventilation. 3 We conclude that airflow through the endotracheal tube is not the obvious cause of tracheal lesions 8 and that damage is most probably related to the high pressure to which these airways are subjected.…”

Bacterial tracheobronchitis. A rare cause of adult airway stenosis

“…Bacterial tracheobronchitis is an extremely rare cause of airway stenosis in adults, although it has been reported in patients who are intubated and mechanically ventilated 3,4 . The most common causes of chronic upper airway obstruction are hypertrophy of the tonsils and adenoids, vocal cord paralysis, tracheal stenosis following tracheostomy or prolonged tracheal intubation, primary and secondary neoplasms, and tracheomalasia 5 .…”