Possible risk factors associated with moderate or severe airway injuries in children who underwent endotracheal intubation

Cordeiro, Anói Castro; Fernandes, José Carlos; Troster, Eduardo Juan

doi:10.1097/01.pcc.0000128894.59583.66

Cited by 66 publications

(47 citation statements)

References 31 publications

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“…'Hospital C' postulated that intraoperative and postoperative management without endotracheal intubation would be feasible and would reduce the days of mechanical ventilation in this population. [3][4][5][6] The present study was undertaken as an analysis of all neonates who underwent ROP laser surgery in any of the three Intermountain Healthcare NICUs between January 2002 and March 2006. Among all those undergoing ROP surgery, we assessed the respiratory modality used the day before surgery, during surgery and for 3 days following surgery.…”

Section: Introductionmentioning

confidence: 99%

Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity

et al. 2007

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Objective: Respiratory support of neonates during and following laser surgery for retinopathy of prematurity (ROP) is commonly accomplished using endotracheal intubation and mechanical ventilation. However, most patients undergoing ROP surgery have been weaned off mechanical ventilation days or weeks before the surgery. When they are electively re-intubated for ROP surgery, it can be difficult to extubate them postoperatively. One of the three level III neonatal intensive care units (NICUs) in the Intermountain Healthcare system initiated a program of using nasopharyngeal prongs, rather than endotracheal intubation, for respiratory support during ROP surgery. Methods:We performed an historic cohort analysis of all neonates undergoing ROP surgery during their NICU stay at the three level III NICU's between 1 January 2002 and 31 March 2006. Data collected included birth weight, gestational age at delivery and corrected gestational age at ROP surgery, whether or not they were intubated in the days immediately preceding the ROP surgery, whether or not they were electively intubated for the ROP surgery, the respiratory modality used during and the 3 days following ROP surgery, and all blood gas determinations and respiratory charges during this period.Results: Fifty-four patients underwent ROP surgery during this period. All 23 from NICUs 'A' and 'B' had endotracheal intubation for surgery, while in NICU 'C' 24 were managed using nasopharyngeal prongs. The birth weights of those intubated for surgery (661±180 g, mean±s.d.) were similar to those not intubated (732±180 g). Similarly, the gestational age at birth did not differ between those intubated for surgery (25.2±1.3 week) and those not (25.6±2.1 week). The day following surgery, 77% (23/30) of those who had been intubated for surgery remained intubated and on mechanical ventilation, whereas only one (4%) of those not intubated for surgery was intubated in the postoperative period (P<0.001). On day 3 following surgery, 50% (15/30) of those intubated for surgery remained intubated and on mechanical ventilation, whereas none of those not intubated for surgery were intubated (P<0.001). Management with nasopharyngeal prongs did not result in higher PCO 2 s, or lower pH values, during or after surgery. Respiratory charges for the 3 days following surgery were $1762±678 (mean±s.d.)/ patient among those intubated versus $357±352/patient for those managed with nasopharyngeal prongs (P<0.001).Conclusions: Neonates undergoing laser surgery for ROP can often be supported intraoperatively and postoperatively using nasopharyngeal prongs, thus avoiding the need for endotracheal intubation.

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Section: Introductionmentioning

confidence: 99%

Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity

et al. 2007

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“…Given the wide variability in each child's response to intubation and the multitude of risk factors involved (e.g., history of traumatic or repeated intubation, size of ETT, prematurity, presence of concurrent gastroesophageal reflux) (38)(39)(40)(41), a generalized clinical model of acquired SGS may not be applicable to all intubated neonates. Hence, serial imaging of each airway would allow clinicians to monitor for edema or fibrosis and make individualized airway management …”

Section: Lr-oct Advantagesmentioning

confidence: 99%

Long-Range Optical Coherence Tomography of the Neonatal Upper Airway for Early Diagnosis of Intubation-related Subglottic Injury

Sharma

Ahuja²,

Wiedmann

et al. 2015

Am J Respir Crit Care Med

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Rationale: Subglottic edema and acquired subglottic stenosis are potentially airway-compromising sequelae in neonates following endotracheal intubation. At present, no imaging modality is capable of in vivo diagnosis of subepithelial airway wall pathology as signs of intubation-related injury.Objectives: To use Fourier domain long-range optical coherence tomography (LR-OCT) to acquire micrometer-resolution images of the airway wall of intubated neonates in a neonatal intensive care unit setting and to analyze images for histopathology and airway wall thickness.Methods: LR-OCT of the neonatal laryngotracheal airway was performed a total of 94 times on 72 subjects (age, 1-175 d; total intubation, 1-104 d). LR-OCT images of the airway wall were analyzed in MATLAB. Medical records were reviewed retrospectively for extubation outcome. Measurements and Main Results:Backward stepwise regression analysis demonstrated a statistically significant association between log(duration of intubation) and both laryngeal (P , 0.001; multiple r 2 = 0.44) and subglottic (P , 0.001; multiple r 2 = 0.55) airway wall thickness. Subjects with positive histopathology on LR-OCT images had a higher likelihood of extubation failure (odds ratio, 5.9; P = 0.007). Longer intubation time was found to be significantly associated with extubation failure.Conclusions: LR-OCT allows for high-resolution evaluation and measurement of the airway wall in intubated neonates. Our data demonstrate a positive correlation between laryngeal and subglottic wall thickness and duration of intubation, suggestive of progressive soft tissue injury. LR-OCT may ultimately aid in the early diagnosis of postintubation subglottic injury and help reduce the incidences of failed extubation caused by subglottic edema or acquired subglottic stenosis in neonates.Clinical trial registered with www.clinicaltrials.gov (NCT 00544427).

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“…5,7,[11][12][13][14][16][17][18] In relation to the complications after extubation, the main factors considered are traumatic tracheal intubation, accidental extubation, tracheal extubation length of time, tracheal tube's size, tracheal tube traction and friction, and balonet's pressure. 5,6,19,22,25,39,41 The results of this study showed an association between complications after extubation and a bigger number of attempts of intubation (Table 1), but it was not possible to demonstrate the relation between these complications and the length of the mechanical ventilation.…”

Section: Discussionmentioning

confidence: 71%

“…Dysphonia may vary from 1 to 80% and in adults, it is more common in females and in patients intubated with large tracheal tube (TT), but these data are not confirmed in pediatric patients. 2,5,6,[19][20][21][22][23][24][25] Incidence of laryngeal edema in pediatric age group may vary from 1% to 47%. It is more common in infants, due to the smaller diameter of the airways, to the relatively smaller diameter of cricoid cartilage in relation to the rest of the airways and the presence of a more fragile epithelium.…”

Section: Introductionmentioning

confidence: 99%

Complicações da intubação traqueal em pediatria

Souza¹,

Carvalho²

2009

Rev. Assoc. Med. Bras.

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Objective. Describe the frequency and the types of complications of tracheal intubation and its main causes. MethOds. Cross-sectional study of inpatients in the UTI Pediátrica (Pediatrics Intensive Care Unit) of Santa Casa de Misericórdia, São Paulo, between May/1998 and December/1999, who were submitted to tracheal intubation over 24 hours. The criteria of exclusion included previous intubation, surgeries or traumas in the cervical region or oropharynx. Results. 147 cases were studied, with ages ranging from one month to 15 years and 3 months. In 31.3% tracheal tubes of improper size were used, and 14.3% needed five or more attempts to be intubated. Intubation was more difficult for resident physicians. The bigger number of attempts of tracheal intubation was related to an increase of traumas, hypoxia, bradycardia, and worsening of Downes' score after extubation. 21.8% of accidental extubation were observed. This rate was related to the worsening of Downes' score and the need of reintubation. Resident physicians also caused a bigger number of traumas and bradycardia. cOnclusiOn. Most of the complications can be attributed to the lack of experience and training of the physician who performed the tracheal intubation; thus, it is important, in order to minimize those incidents, to implement training programs and intensify supervision during tracheal intubation.

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Possible risk factors associated with moderate or severe airway injuries in children who underwent endotracheal intubation

Abstract: We concluded that to prevent morbidity secondary to airway injury, efforts should be directed to avoid reintubation and tube changes in the concerned scenario.

Cited by 66 publications

References 31 publications

Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity

Avoiding endotracheal intubation of neonates undergoing laser surgery for retinopathy of prematurity

Long-Range Optical Coherence Tomography of the Neonatal Upper Airway for Early Diagnosis of Intubation-related Subglottic Injury

Complicações da intubação traqueal em pediatria

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