*Lidia Zawadzka-Głos, Agnieszka Obarska
Effect of duration of intubation on post intubation laryngeal changes in children
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Lidia Zawadzka-Głos, MD, PhD
Introduction. The post intubation complications of the larynx very rare occur in children and they are connected to many factors. We divide the post intubation complications into early and late complications.
It can cicatrized leading to stenosis of subglottic area and in a posterior commissure of the larynx. The endoscopic examination of the changes during prolonged intubation allows us to evaluate the progression of the lesions. The incidence of chronic changes usually is connected with performing tracheotomy in a child in order to keep the patency of the respiratory tract.
Aim. The purpose of the study was an analysis of intubated children who had undergone post intubation complications and a definition the dependence of duration of intubation upon an occurrence of the complications.
Material and methods. A group of 92 children with post intubation complications was analysed. The post intubation complications were the reason of performing a tracheotomy in these children. In each child endoscopic assessment of the larynx and trachea in a general anesthesia was carried out. The duration of the intubation was analysed in each of the examined child.
Results. Tracheostomy due to post intubation complication unable physiological breathing was performed in 92 children. A duration of intubation ranged from 10 to 120 days. Post intubation lesions were related to the duration of intubation. As longer the time of the intubation was, the more serious was the character of changes. More serious changes were observed in premature born children.
Conclusions. Duration of intubation is the major risk factor of the occurrence of post intubation lesions. Prematurely born children who underwent prolonged intubation have worse prognosis. The character of the changes is connected to duration of intubation.
The post intubation complications of the larynx very rare occur in children and they are connected to many factors. The complications could be temporal or they could permanently change the anatomical conditions of the larynx. We divide the post intubation complications into early and late complications. The early complications of the mucosa are nonspecific such as congestion and edema with inflammatory infiltration. The edema of the soft tissue could involve laryngeal vestibule, vocal cords or could localize in subglottic area of the larynx. The continuation of intubation could lead to ulceration and granulation of the mucosa. The ulceration usually occur in posterior part of the larynx, in medial part of the arytenoid, cricoarytenoid joints and anterior part of the cricothyroid membrane. The deep ulceration of perichondrium and cartilage is replaced by late complications such as scars, causing stenosis of the larynx. Granulation tissue often forms in a posterior commissure and subglottic area of the larynx. Occasionally it can cicatrized leading to stenosis of subglottic area and in a posterior commissure of the larynx. The endoscopic examination of the changes during prolonged intubation allows us to evaluate the progression of the lesions. The deep ulceration of wide surface of the posterior part of the glottis and subglottic area are the major risk factor of the chronic larynx changes occurrences and scars, destructing the larynx (1-3). In such cases the decision to carry out tracheotomy should be taken. The chronic post intubation lesions include cicatrix and post intubation granuloma. The scars could occur at any level of the larynx, but predominantly the subglottic area and commissure posterior are predisposition to such changes. The incidence of chronic changes usually is connected with performing tracheotomy in a child in order to keep the patency of the respiratory tract.
The purpose of the study was an analysis of intubated children who had undergone post intubation complications and a definition the dependence of duration of intubation upon an occurrence of the complications.
MATERIAL AND METHODS
The study involved a group of 92 children, who developed post intubation complications of the larynx during an intubation. The tracheotomy was performed for the reason of upper respiratory patency impairment. The larynx endoscopic examination revealed the presence of post intubation changes such as edema, ulceration and scars. The analysis of a group was made regarding the duration of the intubation.
The analysis of duration of intubation and of developmental age of the child at the day of birth, turned out to be interesting. Among all the examined children a division was made to the children who were born on time and the children who were prematurely born. The mean time of intubation of children, who were born on time, was 24.6 days, in comparison to the mean time of intubation of prematurely born children, which was more than twice longer and it was 54.8 days. In examined group of children, prematurely born children required a longer intubation in comparison to children who were born on time.
The precise specification of duration of all patients intubation shows table 1.
Table 1. Duration of intubation (in days).
|0 ≤ x < 10||12||13.04|
|10 ≤ x < 20||15||16.30|
|20 ≤ x < 30||9||9.78|
|30 ≤ x < 40||16||17.39|
|40 ≤ x < 50||10||10.87|
|50 ≤ x < 60||3||3.26|
|60 ≤ x < 70||9||9.78|
|70 ≤ x < 80||4||4.35|
|80 ≤ x < 90||2||2.17|
|90 ≤ x < 100||9||9.78|
|100 ≤ x < 110||1||1.09|
|110 ≤ x < 120||1||1.09|
|120 ≤ x < 130||1||1.09|
n – the amount of patients
Sixteen children were intubated for a period of 30-40 days, which makes 17.39% of all patients. The second large group consists of 15 children, who were intubated for a period of 10-20 days (16.3%). Prolonged intubations over 100 days were sporadic in examined group of patients.
In cases of 65 children out of 92 examined patients, early post intubation changes such as edema and ulcerations were diagnosed.
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