Predicting and managing the development of subglottic stenosis following intubation in children

Rutter, Michael J.; Kuo, I‐Chun

doi:10.1016/j.jped.2019.04.001

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…The risk factors for the development of intubation-related airway complications are well known [ 16 , 17 ]. Our patient developed subglottic stenosis that required to be treated with three balloon laryngoplasty procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Our patient developed subglottic stenosis that required to be treated with three balloon laryngoplasty procedures. The patient was discharged from the hospital without stridor but presented with hoarseness; we therefore believe that it is essential to endoscopically investigate all patients with stridor and hoarseness after 72 h post-extubation [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

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Severe Neurological Manifestation in a Child with Multisystem Inflammatory Syndrome

et al. 2022

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Background and objectives: During the COVID-19 pandemic, we followed with concern the evolution of several children diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C). The purpose of this study is to describe the evolution of MIS-C in a previously healthy 3-year-old girl. Methods: We tracked the daily medical report of all children admitted with suspected MIS-C to the five largest regional hospitals. Results: Our screening identified a child who had several neurological complications associated with MIS-C. We report hematological alterations, transient cardiac dysfunction, and cerebral involvements such as laminar cortical necrosis caused by ischemic stroke. We present the course of treatment and clinical outcome, and other complications such as a severe subglottic stenosis occurring after extubation. Conclusion: Subglottic stenosis is an expected complication after prolonged intubation, and the presence of dysphonia and/or stridor is an important predictive factor. MIS-C with severe neurological alteration may occur in a healthy child, and early diagnosis and treatment with a pulse of corticoid with immunoglobulin are essential for a favorable outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Severe Neurological Manifestation in a Child with Multisystem Inflammatory Syndrome

et al. 2022

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“…It will typically worsen before improving, warranting close monitoring of patients. After 72 hours, if the stridor persists or has a new onset, the airway is severely affected, prompting endoscopic evaluation and intervention [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Subglottic Stenosis in a 16-Month-Old Male in the Setting of Influenza A, Intubation, and Honey Consumption

Jakiel,

Berreta,

Sahhar

et al. 2024

Cureus

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Recurrent episodes of subglottic stenosis are rare in the literature, and the etiologic causes are misunderstood but can be congenital, idiopathic, or iatrogenic in nature. Complications of intubation can result in subsequent inflammation and reactive processes. This case involves a 16-month-old male who suffered from a recurrent episode of subglottic stenosis in the setting of croup, influenza, and honey consumption. He had presented to the emergency department in respiratory distress after ingesting a home remedy of onion juice and honey. He had been discharged one day prior from the pediatric intensive care unit after four days of intubation and a seven-day hospital course with evidence of croup on imaging. He was readmitted, and subglottic edema and narrowing were confirmed via endoscopy, which prompted antibiotic treatment and close monitoring. After three days of monitoring and re-evaluation by bronchoscopy, the patient's condition began to improve, and no intubation was necessary. It is unclear what the cause of recurrent subglottic stenosis is due to the patient's clinical picture being clouded by a potential allergic reaction to honey versus an inflammatory reactive process post-intubation from the previous admission days prior. This case emphasizes the need for further research on the prevalence and etiology of recurrent subglottic stenosis and a deeper understanding of how to optimize diagnosis and treatment.

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“…The most common risk factors for subglottic stenosis, especially in children, include prolonged intubation; the improper selection of endotracheal tube size and inadequate sedation and analgesia; repetitive intubation, and nursing errors, like traumatic suctioning. Other predisposing factors for subglottic stenosis consist of the underlying diseases of the respiratory system, Gastroesophageal Reflux Disease (GERD), premature birth, brain injury, congenital airway disorders, cerebral palsy, Down syndrome, prolonged seizures, viral infection leading to intubation, the inadequate perfusion of the airway mucosa due to hypotension, anemia, sepsis, obesity, diabetes, and shock [4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Mild to moderate cases require medical treatment or bronchoscopic intervention. Moreover, moderate to severe cases require open surgery and tracheostomy [4].…”

Section: Introductionmentioning

confidence: 99%

A 10-year-old Child with Severe Subglottic Stenosis Following Intubation: A Case Report

Chegini

Esfahani

et al. 2021

JQUMS

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Background: Subglottic stenosis is among the most common airway problems in children, i.e., acquired or congenital. More than 90% of acquired cases are secondary to endotracheal intubation and occur iatrogenically. Subglottic stenosis is an unexpected problem that requires timely diagnosis and intervention. Most cases of subglottic stenosis in children are mild to moderate. Case Presentation: The presented patient was a 10-year-old child who, after long intubation due to head trauma following early discharge from the surgical center, was referred to the Children’s Hospital on the same day with a complaint of high fever and shortness of breath. With the development of respiratory distress and cyanosis, the patient was transferred to the intensive care unit. Due to the impossibility of passing the tracheal tube with the appropriate age for the patient, the initial diagnosis of subglottic stenosis was established and a tracheostomy was performed. Diagnostic bronchoscopy confirmed severe subglottic stenosis, and the child was referred to a specialized Ear, Nose, Throat (ENT) center for the repair of the tracheal stenosis. Conclusion: One of the most common causes of stridor in children is subglottic stenosis following prolonged intubation. Recognizing the predisposing factors, prevention, strong clinical suspicion, timely diagnosis, and treatment can prevent further adverse complications or consequences in children.

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Predicting and managing the development of subglottic stenosis following intubation in children

Cited by 11 publications

References 19 publications

Severe Neurological Manifestation in a Child with Multisystem Inflammatory Syndrome

Severe Neurological Manifestation in a Child with Multisystem Inflammatory Syndrome

Recurrent Subglottic Stenosis in a 16-Month-Old Male in the Setting of Influenza A, Intubation, and Honey Consumption

A 10-year-old Child with Severe Subglottic Stenosis Following Intubation: A Case Report

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