The role of gentle ventilation in prevention of subglottic stenosis in the newborn

Abstract

Prolonged endotracheal intubation has become the standard of care in most neonatal units for maintenance of mechanical ventilation in the presence of respiratory distress. Unfortunately this approach has become associated with significant complications, including acquired subglottic stenosis. We have successfully used nasal continuous positive airway pressure to avoid or decrease the incidence and duration of endotracheal intubation. With use of this technique we have been able to significantly reduce sequelae (i.e., bronchopulmonary dysplasia, chronic lung disease, intraventricular hemorrhage) and have not encountered subglottic stenosis in more than 200 cases. The use of this technique may be of significant value in preventing or reducing the incidence of acquired subglottic stenosis.

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

“…Our incidence of 27/1847 (1.5%) in infants with a birth weight of <1500 g is comparable with Suzumura et al 16 and Nicklaus et al 9 who reported incidences of 3.1% and 2.4% respectively. Gaynor and Danoff15 reported an incidence of 0% in infants <1500 g, although they only had a denominator of 128 patients.…”

Tracheotomy and Decannulation Rates in a Level 3 Neonatal Intensive Care Unit: A 12‐Year Study

“…9 Nonetheless, prolonged intubation and traumatic intubation, even in neonates, carries a morbidity and an overall rate of symptomatic subglottic stenosis of 0.2%. 10,11 This report did not attempt to determine if the rate of subglottic stenosis changed during the study period.…”

Bacterial Colonization of Endotracheal Tubes in Intubated Neonates

“…Furthermore, in adults and older children, benefits have been claimed for the use of high-volume low-pressure cuffs, as well as frequent cuff pressure monitoring and soft cuffs at the larynx. 3,5,6 The size of the endotracheal tube relative to the airway lumen has been examined, and recommendations have been made to avoid an excessively tight fit in the subglottis. 7,8 In an effort to minimize friction trauma by tube motion, nasotracheal intubation has been supported and tube fixation devices have also been devised.…”