Review of Intubation in Severe Laryngotracheobronchitis

PEDIATRICS ◽  
1991 ◽  
Vol 87 (6) ◽  
pp. 847-853
Author(s):  
Julie McEniery ◽  
Jonathan Gillis ◽  
Henry Kilham ◽  
Bruce Benjamin
Keyword(s):  
Airway Obstruction ◽  
Endotracheal Tube ◽  
Cardiac Disease ◽  
Nasotracheal Intubation ◽  
Subglottic Stenosis ◽  
Endoscopic Evaluation ◽  
Artificial Airway ◽  
Low Incidence ◽  
Severe Airway Obstruction

Of 208 children who required relief of severe airway obstruction due to laryngotracheobronchitis by an artificial airway (nasotracheal intubation or tracheostomy) during a 10-year-period, 181 (87%) were intubated and later extubated. Twenty-seven children (13%) had tracheostomies performed. The tracheostomies were for severe subglottic narrowing precluding the passage of an adequate size endotracheal tube in 10 children, and for severe endotracheal tube trauma in 17 children. Five children developed acquired subglottic stenosis (2.4% of 208) and 1 of these has a retained tracheostomy. One child died of cardiac disease. The remaining 202 children had no long-term complications of laryngotracheobronchitis, intubation, or tracheostomy. It is concluded that nasotracheal intubation is a satisfactory artificial airway for laryngotracheobronchitis. Endoscopic evaluation in a selected group of these children will identify those with significant intubation trauma or severe subglottic narrowing in whom continued intubation may cause permanent subglottic damage. The low incidence of acquired subglottic stenosis in this series supports the practice of selective endoscopy and tracheostomy.

Management of the Extubation Problem in the Premature Child

1980 ◽  
Vol 89 (6) ◽  
pp. 508-511 ◽  
Author(s):  
Robin T. Cotton ◽  
Allan B. Seid
Keyword(s):  
Endotracheal Tube ◽  
Ventilatory Support ◽  
Disease Process ◽  
Upper Respiratory Tract ◽  
Endoscopic Evaluation ◽  
Newborn Period ◽  
Edema Formation ◽  
Premature Child ◽  
Upper Respiratory

Long-term endotracheal intubation is a widely established means of giving ventilatory support in the newborn period. Though such long-term intubation is well tolerated by the premature infant, laryngeal complications do occur and extubation may be impossible even though the initial disease process for which the intubation was performed has resolved. In such a situation, careful endoscopic evaluation of the upper respiratory tract is advocated to identify the site of the problem. If subglottic edema or mucosal ulceration in the subglottic area is the site of the damage and if, during endoscopic evaluation immediately following removal of the endotracheal tube, the subglottic area starts to narrow because of edema formation or edema fluid filling up compressed granulation tissue, then a split of the cricoid in the midline anteriorly, leaving the endotracheal tube in as a stent, appears to be a preferable alternative to performing a tracheotomy. Of 12 consecutive patients, 9 have been successfully extubated.

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

1992 ◽  
Vol 101 (10) ◽  
pp. 815-820 ◽  
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.

Paediatric tracheostomy

1987 ◽  
Vol 101 (9) ◽  
pp. 929-935 ◽  
Author(s):  
W. J. Newlands ◽  
W. S. McKerrow
Keyword(s):  
Airway Obstruction ◽  
Complication Rate ◽  
Acute Infection ◽  
Nasotracheal Intubation ◽  
Lower Airway ◽  
Artificial Airway ◽  
Long Duration ◽  
Nasotracheal Tube ◽  
Successful Employment ◽  
Lower Airway Obstruction

AbstractFifty-seven operations on 53 patients represents the total experience of tracheostomy in children under 13 years during 1964–1985 in an area with half a million inhabitants. No complications occurred during surgery and no deaths were related to the operations. Complications followed 16 out of 30 (53%) operations on children under three years and four out of 27 (15%) of the remainder, an overall complication rate of 35%. Many fewer operations have been required since 1973 because of the successful employment of nasotracheal intubation in the treatment of upper and lower airway obstruction caused by acute infection. Obstruction by-pass remains the commonest function of tracheostomy, with congenital lesions and trauma now the commonest causes of obstruction as opposed to acute infection in the earlier years. Despite the successful use of nasotracheal intubation there were absolute indications for tracheostomy—blockage of the nasotracheal tube; inability to intubate a child with epiglottitis; and necessity for an artificial airway of long duration.

Giant Suprastomal Granuloma as a Laryngeal Mass

1993 ◽  
Vol 102 (9) ◽  
pp. 701-704 ◽  
Author(s):  
Gregory K. Hartig ◽  
Brian J. Wiatrak ◽  
Charles M. Myer ◽  
Charles M. Bower
Keyword(s):  
Airway Obstruction ◽  
Pediatric Population ◽  
Endoscopic Approach ◽  
Common Occurrence ◽  
Endoscopic Evaluation ◽  
Open Excision

The presence of suprastomal granulomas after tracheotomy is a common occurrence. Under most circumstances, this never becomes clinically relevant. However, in the pediatric population, granulomas can on occasion cause partial or complete airway obstruction after decannulation. This report describes 2 cases of giant suprastomal granulomas that presented as laryngeal masses. These cases stress the indications for routine endoscopic evaluation in patients with long-term tracheotomies. Also, the treatment of extensive suprastomal granulomas requires open excision, which differs from the endoscopic approach recommended for smaller granulomas.

Laryngeal Surgery in the Pediatric Patient

1980 ◽  
Vol 89 (5_suppl) ◽  
pp. 146-149
Author(s):  
Blair Fearon
Keyword(s):  
Airway Obstruction ◽  
Pediatric Patient ◽  
Signs And Symptoms ◽  
Subglottic Stenosis ◽  
Endoscopic Approach ◽  
Primary Concern ◽  
Laryngeal Surgery ◽  
Laryngeal Disease ◽  
Conventional Instrumentation

The primary concern in laryngeal surgery in the infant and child is to relieve airway obstruction, rather than phonation. Because airway obstruction above the larynx may simulate or be confused with laryngeal pathology, these are described as the signs and symptoms of laryngeal disease. Although tracheotomy in the infant is frequently said to be a cause of a long-term problem, the procedure can be carried out in the smallest premature quite safely and without an extubation problem. The author's method of performing the operation is described. Most laryngeal surgery in the child is performed by the endoscopic approach, special scopes being used for special purposes. In addition to conventional instrumentation the cryoprobe and CO2 laser are employed. The author's method of treating glottic and subglottic stenosis is outlined.

Ten-Year Review of Pediatric Tracheotomy

1983 ◽  
Vol 92 (4) ◽  
pp. 398-400 ◽  
Author(s):  
Peter Carter ◽  
Bruce Benjamin
Keyword(s):  
Airway Obstruction ◽  
Premature Infants ◽  
Granulation Tissue ◽  
Reconstructive Surgery ◽  
Nasotracheal Intubation ◽  
Craniofacial Abnormalities ◽  
Pediatric Hospital ◽  
Acute Epiglottitis ◽  
Minimal Morbidity

One hundred sixty-four consecutive tracheotomies are reviewed over the 10-year period 1972–1981. Early in the series acute inflammatory airway obstruction was the major indication for tracheotomy, being 60% of cases in the first 3 years. In the last 3 years this fell to approximately 15%. After 1975 nasotracheal intubation replaced tracheotomy for acute epiglottitis. More recently it has become the treatment of choice for acute laryngotracheobronchitis. Tracheotomy prior to reconstructive surgery for major craniofacial abnormalities is becoming more frequent. Acquired subglottic stenosis is not a problem in our hospital despite the use of long-term nasotracheal intubation in premature infants, and no tracheotomies were performed for this indication. There were few major complications. Decannulation difficulties were due to obstruction by stomal granulation tissue or displaced flap of anterior tracheal wall. There was no case of hemorrhage, no posttracheotomy stenosis, and no death was attributable to tracheotomy. These results demonstrate that in a major pediatric hospital tracheotomy is a relatively safe and effective procedure with minimal morbidity.

Local Delivery of Mometasone Furoate from an Eluting Endotracheal Tube Reduces Airway Morbidity Following Long-Term Animal Intubation

2021 ◽  
Author(s):  
Forsan Jahshan ◽  
Aiman Abu Ammar ◽  
Offir Ertracht ◽  
Netanel Eisenbach ◽  
Amani Daoud ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Local Delivery ◽  
Mometasone Furoate

scholarly journals Mucosal Changes in the Trachea and Main Bronchi of Newborn Infants after Nasotracheal Intubation

1975 ◽  
Vol 3 (3) ◽  
pp. 209-217 ◽  
Author(s):  
G. C. Fisk ◽  
W. de C. Baker
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Squamous Metaplasia ◽  
Nasotracheal Intubation ◽  
Newborn Infants ◽  
Respiratory Epithelium ◽  
Lower Trachea ◽  
Nasotracheal Tube ◽  
Mucosal Changes ◽  
The Right

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.

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