Abstract
PurposeProlonged endotracheal intubation may lead to laryngeal damage, with stridor being the most relevant clinical symptom. Our objective was to determine the incidence of post-extubation stridor and their clinical consequences in children within a tertiary referral center and to identify contributing factors.Methods150 children, aged 0–16 years, intubated for more than 24 h were prospectively enrolled until discharge of the hospital. Potential relevant factors, thought to mediate the risk of laryngeal damage, were recorded and analyzed.ResultsThe median duration of intubation was 4 days, ranging from 1 to 31 days. Stridor following extubation occurred in 28 patients (18.7%); 3 of them required reintubation due to respiratory distress and in 1 child stridor persisted for which a surgical intervention was necessary. In multivariate analyses, we found the following independent predictors of stridor: intubation on the scene, the use of cuffed tubes and lower age.ConclusionDespite a high incidence for post-extubation stridor, only few children need reintubation or surgical intervention as a result of post-extubation lesions. Intubation on the scene, the use of cuffed tubes and young age are associated with a significant increased risk of post-extubation stridor. Awareness of these factors gives the possibility to anticipate on the situation and to minimize laryngeal injury and its possible future consequences.
Highlights
Prolonged endotracheal intubation may lead to laryngeal damage
Postextubation laryngeal lesions lead to a life-threatening laryngotracheal stenosis, which presents with typical signs of upper airway obstruction like chest retractions, dyspnea, and inspiratory stridor
Data were collected from the Patient Data Management System (PDMS), electronic patient system (Elpado and Hix) and medical charts at the Pediatric Intensive Care Unit (PICU) by personnel who were not During the inclusion period, 199 patients were admitted to the PICU of Sophia Children’s Hospital and were intubated for more than 24 h
Summary
Prolonged endotracheal intubation may lead to laryngeal damage. Pressure from the tube is thought to cause ischemia and erosion and ulceration of the laryngeal mucosa; resulting in the formation of scar tissue. Previous studies have shown that the majority of patients show some form of laryngeal injury after extubation, varying from mild edema to vocal fold immobility. Most of these injuries go unnoticed and heal spontaneously with no or minimal consequences [3,4,5,6,7]. Several significant associated factors leading to laryngeal injury and laryngotracheal stenosis have been identified like duration of intubation, multiple intubations, and infection [5, 8,9,10,11,12,13]. The factors age, gender, low gestational age, low birth weight, (congenital) narrow larynx, gastro-esophageal reflux, traumatic intubation, and inappropriate tube size are considered to contribute to the development of laryngeal
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