Severe acquired subglottic stenosis in neonatal intensive care graduates: a case–control study

Thomas, Rebecca; Rao, Shripada; Minutillo, Corrado; Vijayasekaran, Shyan; Nathan, Elizabeth

doi:10.1136/archdischild-2017-312962

Cited by 47 publications

(41 citation statements)

References 34 publications

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“…Similarly, Thomas et al showed that longer duration of intubation was one of the factors that was associated with acquiring severe subglottic stenosis in neonates. 18 However, the number of intubation encounters, whether surgical or catherization, was not associated with acquisition of an airway abnormality or with the incidence of DI. This suggested that acquired lesions may have resulted from a direct surgical insult rather from repetitive airway instrumentation.…”

Section: Discussionmentioning

confidence: 88%

Airway Abnormalities in Patients With Congenital Heart Disease: Incidence and Associated Factors

Foz

Peyton

Staffa

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Discussionmentioning

confidence: 88%

Airway Abnormalities in Patients With Congenital Heart Disease: Incidence and Associated Factors

Foz

Peyton

Staffa

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…There was no single case of de novo clinically significant acquired SGS with the use of cuffed endotracheal tubes in our institution over the last 5 years. Risk factors for subglottic stenosis such as multiple intubations, traumatic intubation, >1 weeks duration intubation, and low weight have been explored in previous studies . All eight patients with acquired SGS were premature neonates initially intubated with uncuffed tubes in neonatal ICUs outside our institution.…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors for subglottic stenosis such as multiple intubations, traumatic intubation, >1 weeks duration intubation, and low weight have been explored in previous studies. 2,[13][14][15] All eight patients with acquired SGS were premature neonates initially intubated with uncuffed tubes in neonatal ICUs outside our institution.…”

Section: Discussionmentioning

confidence: 99%

A retrospective observational study of acquired subglottic stenosis using low‐pressure, high‐volume cuffed endotracheal tubes

Greaney

Russell

Dawkins

et al. 2018

Pediatric Anesthesia

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Summary Introduction The safety of cuffed endotracheal tubes in the neonatal and critically ill pediatric population continues to be questioned due to the theoretical risk of acquired subglottic stenosis. The incidence of acquired subglottic stenosis in the high‐risk mixed surgical and medical critically ill pediatric cohort using high‐volume, low‐pressure cuffed endotracheal tube policy has not yet been described. The aim of our study was to describe and evaluate the use and complication rate of cuffed ETT's in our unit over a 5‐year period. Methods We defined clinically significant subglottic stenosis as a positive stenotic finding of endotracheal tube‐related pathology on a microlaryngoscopy within 6 months of invasive ventilation. All patients admitted through our pediatric critical care unit from January 10, 2012 to January 25, 2017 were matched against our theater management system database for the same period. We reviewed all matching patients’ baseline demographics, comorbidities, intubation/endotracheal tube history, and subsequent surgical management. Results Of 5309 pediatric critical care unit admissions (61% ventilated) and 1251 microlaryngoscopies, 23 children had endoscopic findings of clinically significant endotracheal tube‐related pathology, reflecting 0.68% of all intubated patients. Eight patients developed acquired subglottic stenosis. All those requiring major surgical correction were ex‐premature neonates initially intubated with uncuffed tubes in an external neonatal intensive care. No patient initially intubated with a cuffed endotracheal tube developed subglottic stenosis requiring surgical correction. Conclusion We report no single case of acquired subglottic stenosis in our cohort that required major surgical correction from a cuffed endotracheal tube during a 5‐year period. The introduction of a policy of appropriate placement and maintenance of low‐pressure, high‐volume cuffed endotracheal tubes in the pediatric critical care unit was not associated with an increased rate of endotracheal tube‐related subglottic trauma.

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“…Pediatric subglottic stenosis primarily results from two causes: iatrogenic injury and congenital deformities. While improvements in intubation techniques and neonatal care protocols have helped reduce the published rates of subglottic stenosis in neonates from nearly 8% to 0-2% since the 1970s, [1][2][3] it remains a commonly encountered, resourceintensive, and difficult-to-treat condition. Furthermore, traumatic intubation has been identified as an independent risk factor in the development of acquired subglottic stenosis (ASGS).…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial of Dexamethasone as a Prophylactic Treatment for Subglottic Stenosis in a Rabbit Model

Wistermayer

Escalante

McIlwain

et al. 2020

Ann Otol Rhinol Laryngol

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Objective: Iatrogenic injury is a common cause of subglottic stenosis (SGS). We investigated the role of pre-injury dexamethasone as a preventive treatment for iatrogenic subglottic stenosis. Methods: 16 New Zealand White rabbits were used in an IACUC approved study. Subjects were divided into two groups: intramuscular dexamethasone (DEX) at a dose of 2 mg/kg 15 minutes prior to an endoscopic injury to create SGS, and the same injury creation with a preoperative intramuscular saline (SAL) injection. Three independent, blinded raters evaluated endoscopic images to obtain cross sectional area (CSA) airway measurements. Rabbit airways were measured just prior to injury and at one week post-injury. All subjects were provided as-needed postoperative steroids and buprenorphine for symptoms of respiratory distress. Data analysis was performed using Student t-test. Intraclass correlation coefficients were used to assess inter-rater agreement. Results: All subjects survived to the one-week post-injury airway evaluation. There was no difference in airway size between groups prior to injury ( P = .28). Subjects in the DEX group demonstrated an average stenosis of 20.3% (95% CI 10.2-30.5) at one week compared to 60.6% (95% CI 40.3-80.9) in the SAL group ( P = .01). Subjects in the control group required significantly more doses of postoperative dexamethasone ( P = .02). Inter-rater agreement for between raters was excellent (ICC = .88). Conclusion: This is the first study to examine the role of pre-injury glucocorticoids in preventing iatrogenic subglottic stenosis. In our model, a single dose of intramuscular dexamethasone given prior to a subglottic injury resulted in a statistically significant reduction in airway stenosis. This research suggests that administering systemic dexamethasone should be considered prior to any procedure that may injure the subglottis, including traumatic intubation, to prevent iatrogenic subglottic stenosis.

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Severe acquired subglottic stenosis in neonatal intensive care graduates: a case–control study

Abstract: SASGS is a serious consequence of intubation for mechanical ventilation in NICU graduates, especially in preterm infants. Minimising trauma during intubations, avoiding recurrent extubation/reintubations and using appropriate sized ETTs may help prevent this serious complication.

Cited by 47 publications

References 34 publications

Airway Abnormalities in Patients With Congenital Heart Disease: Incidence and Associated Factors

Airway Abnormalities in Patients With Congenital Heart Disease: Incidence and Associated Factors

A retrospective observational study of acquired subglottic stenosis using low‐pressure, high‐volume cuffed endotracheal tubes

A Randomized Controlled Trial of Dexamethasone as a Prophylactic Treatment for Subglottic Stenosis in a Rabbit Model

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