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© Borgis - New Medicine 4/2014, s. 129-132
*Lidia Zawadzka-Głos, Krzysztof Ślączka
Analysis of early post intubation lesions in larynx after prolonged intubation in children
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Lidia Zawadzka-Głos, MD, PhD
Summary
Introduction. Respiratory failure followed by endotracheal intubation can lead to severe post intubation laryngeal lesions in small group of patients. Complikations are classified as acute (early) and chronic on a base the laryngoscopy findings.
Aim. To assess the statistical relationship between early post intubation complications and intubation duration, birth weight and gestational age.
Material and methods. The study included 65 children threated in Pediatric Otolaryngology Department presented with early post intubation complication such as subglottic edema, subglottic ulceration, granulation and non-specific lesions. The study was based on the medical records taken during direct laryngoscopy procedure as well as on the demographic factors, such as birth weight and gestational age. Additional factor included into the study was duration of intubation.
Results. Most of the acute lesions of intubated larynx depend on trauma of mucous membrane. Disfunction of mucosal blood supply during intubation leads to inflammation, edema, infection, ulceration, necrosis or destruction of laryngeal cartilages. Not only the local risk factors matter but also the demographic factors are important. Endoscopy of larynx makes it possible to determine the progression of lesions. Our study revealed, that early post intubation complications such as edema were more likely to affect children with advanced gestational age or higher birth weight. Moreover, the subglottic edema appeared in the group of children with considerably shorter intubation duration. However, the subglottic ulcerations in children are significantly correlated with lower birth weight.
Conclusion. early post intubation lesions, such as edema and subglottic ulcerations are clinically important. Early post intubation lesions strongly depend on the intubation duration, prematurity and low birth weight.
INTRODUCTION
In children prolonged endotracheal intubation is commonly used in cases of respiratory failure and it had replaced tracheostomy procedure in this condition. Most of the paediatric patients have no complications related to intubation, but in about 1-2% of cases, a severe post intubation lesions in larynx may occur. Lesions in larynx induced by prolonged intubation are classified into two groups, in accordance with the direct laryngoscopy findings (1, 2). The first group includes acute lesions observed during intubation period or in early days after extubation. The second includes chronic lesions diagnosed a week or later after extubation. Early post intubation lesions include: edema, ulceration, granulation, non-specific lesions as well as direct injury related to intubation procedure.
MATERIAL AND METHODS
A study was performed on a group of 65 pediatric patients with tracheostomy carried out due to prolonged intubation. Based on medical records from endoscopy of larynx, an early post intubation lesions as edema, ulceration, granulation, non-specific lesions as well as acute injuries related to intubation procedure were defined. Statistical relationship between early lesion occurrence and intubation duration, birth weight and gestational age was analyzed.
RESULTS
In a group of 65 patients following conditions were diagnosed: subglottic edema in 30 cases (46.15%), subglottic ulceration in 29 cases (44.62%), acute subglottic post intubation granulation in 5 cases (7.69%), early non-specific lesions in 3 cases (4.62%) and acute injuries related to intubation procedure in 3 cases (4.62%). Some of the patients were diagnosed with more than one post intubation lesion. In our study, only subglottic edema and subglottic ulceration have a statistical significance (tab. 1).
Table 1. Relationship between subglottic edema and duration of intubation.
 NMedianMeanSD
No edema3559.057.231.9
Edema3035.542.325.0
In total6545.050.329.7
U Mann-Whitney test: Z = 2.101; p = 0.0356
The mean duration of intubation in children with subglottic edema was of 42.3 days and it was significantly shorter than it was in other children with early post intubation lesions. The mean duration of intubation in other children was of 57.2 days (tab. 2).
Table 2. Relationship between subglottic edema and gestational age.
 NMedianMeanSD
No edema353231.45.5
Edema303634.53.7
In total653632.85.0
U Mann-Whitney test: Z = -2.105; p = 0.0353
The mean gestational age in children with subglottic edema was of 34.5 weeks. The mean gestational age in other children with early post intubation lesions was of 31.4 weeks and it was significantly shorter than it was in children with subglottic edema.
The mean birth weight in children with subglottic edema was of 2310 g. The mean birth weight in other children was of 1797.9 g. It shows that the subglottic edema appeared mainly in children with higher birth weight (tab. 3).
Table 3. Relationship between subglottic edema and birth weight.
 NMeanSD
No edema351797.91067.3
Edema302310.0898.4
In total652034.21018.4
Student’s t-distribution: t = -2.073; df = 63; p = 0.0423; F-test: p = 0.3470
The duration of intubation was estimated to be an important clinical part of the study. An assessment of relationship between ulceration occurrence and duration of intubation was made and revealed that in a group of children with subglottic ulceration the mean duration of intubation was the longest (61.7 days). The difference is significant because in the group of children with other complications the mean duration of intubation was of 41.2 days. Subglottic ulceration is significantly correlated with longer duration of intubation (tab. 4).
Table 4. Relationship between subglottic ulceration and duration of intubation.
 NMedianMeanSD
No ulceration3635.541.226.4
Ulceration2960.061.730.0
In total6545.050.329.7
U Mann-Whitney test: Z = -2.827; p = 0.0047
The analysis of relationship between the gestational age and subglottic ulceration occurrence revealed that children of shorter gestational age more often had early complications such as subglottic ulcerations. The mean gestational age was calculated: for the group of subglottic ulceration was of 30.2 weeks and for the others was of 34.9 weeks. Subglottic ulceration was relevantly more often diagnosed in children of shorter getstional age (tab. 5).
Table 5. relationship between subglottic ulceration and gestational age.
 NMedianMeanSD
No ulceration3637.034.93.5
Ulceration2929.030.25.3
In total6536.032.85.0
U Mann-Whitney test: Z = 3.7099; p = 0.0002
The mean birth weight in children with subglottic ulceration was of 1538.5 g. The mean birth weight in other children was of 2433.6 g. There is a considerable difference in birth weight in both groups. In our study a subglottic ulceration is significantly correlated with a low birth weight (tab. 6).
Table 6. Relationship between subglottic ulceration and birth weight.
 NMedianMeanSD
No ulceration362695.02433.6874.7
Ulceration291130.01538.5977.0
In total652050.02034.21018.4
Student’s t- distribution: t = 3.8927; df = 63; p = 0.0002 ; F-test p = 0.5303

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otrzymano: 2014-11-04
zaakceptowano do druku: 2014-11-28

Adres do korespondencji:
*Lidia Zawadzka-Głos
Department of Pediatric Otolaryngology Medical University of Warsaw
24 Marszałkowska Str., 00-576 Warsaw, Poland
tel./fax: +48 (22) 628-05-84
e-mail: laryngologia@litewska.edu.pl

New Medicine 4/2014
Strona internetowa czasopisma New Medicine