Emergency Endotracheal Intubation With a Rigid Stylet of an Infant With Severe Subglottic Stenosis

AbstractIn neonates, acquired subglottic stenosis (SGS) is the most serious long term complication of endotracheal intubation. In this case report, we describe the pathological changes in the larynx of a child who died two years after successful treatment, involving corrective surgery, for neonatally acquired SGS. Stenosis, due to dense fibrous connective tissue, was still present at death. However, there was evidence that there had been growth of the laryngeal cartilages. Disruption of the laryngeal cartilages was present anteriorly due to the antecedent surgery but major cricoid cartilage injury secondary to intubation was not seen. The crico-arytenoid joints demonstrated ankylosis and to this was attributed the abnormal quality of voice noted in the child at follow-up. The pathological changes are considered in relation to the pathology of endotracheal intubation and pathogenesis of acquired subglottic stenosis.

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Subglottic Ulceration and Healing following Endotracheal Intubation in the Neonate: A Morphometric Study

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949210101003 ◽

1992 ◽

Vol 101 (10) ◽

pp. 815-820 ◽

Cited By ~ 23

Author(s):

Stephen J. Gould ◽

Martin Young

Keyword(s):

Endotracheal Tube ◽

Endotracheal Intubation ◽

Ulcer Healing ◽

Squamous Epithelium ◽

Subglottic Stenosis ◽

Acute Injury ◽

Morphometric Study

In neonates, acquired subglottic stenosis is the most serious long-term complication of endotracheal intubation and is due primarily to posttraumatic fibrosis of the infant larynx. We have examined 78 larynges, 75 of which were intubated, from infants ranging in gestation from 22 to 40 weeks, and who survived from a few hours to up to 300 days. Each larynx was morphometrically assessed for the extent of acute injury, indicated by the percentage of epithelial loss, and healing, indicated by the percentage of a subglottic ulcer covered by metaplastic squamous epithelium. Results show that acute injury is almost invariable, and up to 100% of the subglottic epithelium may be lost within a few hours of intubation, but that progression of injury is relatively short-lived. Ulcer healing starts after a few days, rapidly progresses from day 10, and in the majority of cases is complete after 30 days. This study suggests that long-standing acute injury in the subglottis is the exception rather than the rule, even with the endotracheal tube remaining in place.

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CANINE MODEL OF SUBGLOTTIC STENOSIS SECONDARY TO PROLONGED ENDOTRACHEAL INTUBATION

The Laryngoscope ◽

10.1288/00005537-198207000-00018 ◽

1982 ◽

Vol 92 (7) ◽

pp. 805-809 ◽

Cited By ~ 31

Author(s):

Gabriel Marshak ◽

William John Doyle ◽

Charles D. Bluestone

Keyword(s):

Endotracheal Intubation ◽

Canine Model ◽

Subglottic Stenosis

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Subglottic stenosis after nasal endotracheal intubation.

BMJ ◽

10.1136/bmj.2.5511.451 ◽

1966 ◽

Vol 2 (5511) ◽

pp. 451-452 ◽

Cited By ~ 6

Author(s):

T. H. Taylor ◽

D. A. Nightingale ◽

B. R. Simpson

Keyword(s):

Endotracheal Intubation ◽

Subglottic Stenosis

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Treatment of Iatrogenic Subglottic Stenosis by Therapeutic Fibreoptic Bronchoscopy

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i2.41379 ◽

2019 ◽

Vol 13 (2) ◽

pp. 64-68

Author(s):

Nurun Nahar Fatema Begum ◽

Jesmin Sultana ◽

Md Ferdousur Rahman Sarker ◽

Sabina Yasmeen ◽

Maj Bijoy Kumar Das ◽

...

Keyword(s):

Endotracheal Tube ◽

Endotracheal Intubation ◽

Young Infant ◽

Invasive Procedure ◽

Armed Forces ◽

Subglottic Stenosis ◽

Fibreoptic Bronchoscopy ◽

Tracheal Mucosa ◽

Common Procedure ◽

Cuffed Endotracheal Tube

Endotracheal intubation is a common procedure in intensive care unit. It still qualifies as an invasive procedure. Prolonged endotracheal intubation or intubation with cuffed endotracheal tube in a newborn or young infant is a risk factor for the development of subglottic stenosis. It usually presents with stridor in childhood. The most likely mechanism of subglottic stenosis is an injury of tracheal mucosa, with secondary scar healing that consequently leads to the development of some degree of subglottic stenosis. Depending on the degree of subglottic stenosis, patients may be asymptomatic for a long time or symptoms can occur within several weeks. The incidence of stenosis is very low if intubation lasts less than a week. Sometimes the patient may develop severe subglottic stenosis after short-term endotracheal intubation. Intubation with cuffed endotracheal tube in newborn results in pressure necrosis and sloughing followed by subglottic stenosis. This article presents a case of a patient (Baby A) who had intubation with cuffed tube which landed to airway problem and stenosis and was managed successfully by taking help from an expert pediatric pulmonologist of a neighbouring country. Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 64-68

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Use of the carbon dioxide laser with the Montgomery T-tube in the management of extensive subglottic stenosis

The Journal of Laryngology & Otology ◽

10.1017/s0022215100121000 ◽

1992 ◽

Vol 106 (9) ◽

pp. 829-831 ◽

Cited By ~ 10

Author(s):

Edward Whitehead ◽

M. A. Salam

Keyword(s):

Carbon Dioxide ◽

Endotracheal Intubation ◽

Tracheal Stenosis ◽

Carbon Dioxide Laser ◽

Scar Tissue ◽

Subglottic Stenosis ◽

The Other ◽

Laser Vaporization ◽

Complete Obstruction ◽

T Tube

AbstractSubglottic and tracheal stenosis frequently present difficulties in management.Two cases of subglottic stenosis occurring after prolonged endotracheal intubation are presented where the vertical length of complete obstruction by scar tissue was greater than 2.5 cm. One case was successfully managed by the use of the laser and immediate insertion of a stent. The other case still requires subglottic stenting, although an excellent lumen was established by laser vaporization of the stenosed segment.

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Predictive Factors of Cricoid Ring Size in Adults in Relation to Acquired Subglottic Stenosis

Otolaryngology ◽

10.1177/019459988309100212 ◽

1983 ◽

Vol 91 (2) ◽

pp. 177-182 ◽

Cited By ~ 13

Author(s):

James A. Koufman ◽

James K. Fortson ◽

M. Stuart Strong

Keyword(s):

Endotracheal Intubation ◽

Cross Section ◽

Upper Airway ◽

Causative Factor ◽

Subglottic Stenosis ◽

Ring Size ◽

Short Term ◽

Prolonged Intubation ◽

Finger Length ◽

Autopsy Specimens

Subglottic stenosis secondary to endotracheal intubation is a distinct clinical entity. Prolonged intubation is an important causative factor, but even short-term endotracheal intubation with too large a tube can damage the cricoid sufficient to cause delayed subglottic stenosis. After studying cricoid size and other factors in 130 adult laryngectomy and autopsy specimens, the following conclusions were reached: (1) The subglottic cricoid is the smallest, fixed cross section in the upper airway. (2) Even if height is comparable, women have smaller cricoid diameters than men. (3) Height is the best predictor of cricoid size. (4) Weight and race are not accurate predictors. (5) Third finger length and cricoid size correlate well, particularly in men. (6) Thus height and third finger length can be used to choose the proper endotracheal tube for adults.

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