Post-intubation subglottic stenosis in children: analysis of clinical features and risk factors

Abstract

Introduction: Subglottic stenosis (SGS) is one of the most common causes of upper airway obstruction among children. The most important factor that affects the development of SGS is endotracheal intubation. In this study, patients diagnosed with post-intubation subglottic stenosis were examined, and the factors contributing to the development of stenosis, as well as the demographic features of the patients, are discussed. Methods: This retrospective study included 104 patients admitted to Bezmialem Vakif University. Bronchoscopy performed due to post-intubation respiratory symptoms between the 2011 and 2016. The demographic features of 50 patients with SGS and 54 patients without SGS, the number and duration of intubations, and the history of hypoxia and infection were evaluated. Results: The mean age of the patients with SGS detected by bronchoscopy was 12.6 months. The female/male ratio was 0.9. The mean duration of intubation was 27.5 days in the patients with SGS, whereas it was 9.9 days in the patients without SGS. In the SGS group, the mean leukocyte count was 16988/mm3 (min-max: 5600 37800/mm3) and the mean CRP value was 15,1 (min-max: 0.02-70), whereas in the patients without SGS had a mean leukocyte count of 13558/mm3 (min-max:2400-36120/mm3) and a mean CRP value of 7,3 (min-max:0.02-50). An intake of oxygen at a concentration of 30% and over during intubation was required in 31 patients with SGS (62%) and in 14 patients without SGS (26%) to maintain the oxygen saturation level at 95% and above. Conclusion: The duration of intubation, increased levels of leukocytes and CRP, and hypoxia were important factors for the development of SGS in intubated patients.