On the Pathogenesis of Laryngeal Injuries Following Prolonged Intubation

Association Between Length of Intubation and Subglottic Stenosis in Children

“…Historically tracheostomy was indicated to prevent laryngeal damage during MV 19,20. According to a randomized prospective study, there is benefit of an early tracheostomy approach during MV in adults 21.…”

“…Historically tracheostomy was indicated to prevent laryngeal damage during MV. 19,20 According to a randomized prospective study, there is benefit of an early tracheostomy approach during MV in adults. 21 Further studies are necessary to define the benefit of tracheostomy after a specific time period of intubation versus the risks of a surgical procedure in the pediatric population.…”

Prolonged Intubation Versus Tracheostomy in the Adult

“…Laryngeal damage (erythema, inflammation, or mucosal ulceration) is invariably found and is most severe over the vocal processes of the arytenoid cartilages, the posterior commissure, and the posterior-lateral subglottis (Fig 5) [35,[56][57][58][59][60][61][62]. These studies further pointed out that two variablesduration of TLI and size of the tracheal tube-have an important influence on the degree of laryngeal damage.…”

“…These observations, coupled with the increasing number of case reports on laryngeal complications of TLI [52,[63][64][65][66][67][68], led many physicians to believe that prolonging TLI for more than 1 to 2 days would lead to an unacceptably high rate of serious laryngeal complications [59,69]. However, these animal and postmortem studies were incomplete because they failed to correlate laryngeal histopathology with clinical sequelae.…”

“…These studies further pointed out that two variablesduration of TLI and size of the tracheal tube-have an important influence on the degree of laryngeal damage. Mucosal ulcerations were apparent after only several hours of TLI [55,58,60,61] and became progressively deeper and wider as the duration of TLI was lengthened [56][57][58][59][60][61][62]. The larger the tracheal tube in relation to laryngeal size, the more severe the subsequent laryngeal damage [55][56][57].…”