Association of endotracheal tube repositioning and acute laryngeal lesions during mechanical ventilation in children.

Abstract

The objective of this study is to determine the incidence of post-extubation acute laryngeal lesions in a pediatric intensive care unit (PICU) and potential risk factors. Children, aged 28 days to 5 years, admitted to the PICU who required endotracheal intubation for at least 24 h were enrolled. Exclusion criteria were a previous intubation, history of laryngeal disease, current or past tracheostomy, the presence of craniofacial malformations and patients considered on palliative care. All patients underwent flexible fiber-optic laryngoscopy (FFL) not later than 8 h after extubation. A blinded researcher identified and classified laryngeal lesions based on recorded media. 231 children were enrolled between November 2005 and December 2015. At FFL examination, 102 children (44.15%) presented moderate to severe laryngeal lesions. On a multivariable analysis, we found that for each additional day with repositioning of the endotracheal tube, there was an increase of 7.3% (RR 95% CI 1.012-1.137; P = 0.018) on the baseline risk of developing moderate to severe acute laryngeal lesions. Furthermore, for each additional dose of sedation per day of intubation, there was also an increase of 3.5% on the same baseline risk (RR 95% CI 1.001-1.070; P = 0.041). The amount of tube repositioning episodes and the need for extra doses of sedation (as a proxy for possible agitation) were found to be associated with acute laryngeal lesions. Adequate sedation and minimized tube repositioning should be pursued to possibly prevent the development of post-extubation airway compromise.

• Authors: Denise Manica, Catia de Souza Saleh Netto, Cláudia Schweiger, Leo Sekine, Larissa Valency Enéas, Denise Rotta Pereira, Gabriel Kuhl, Paulo Roberto Antonacci Carvalho, Paulo José Cauduro Marostica
• Journal: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Eur Arch Otorhinolaryngol) Vol. 274 Issue 7 Pg. 2871-2876 (Jul 2017) ISSN: 1434-4726 [Electronic] Germany
• PMID: 28439690 (Publication Type: Journal Article)

Chemical References

• Hypnotics and Sedatives

Topics

• Brazil (epidemiology)
• Child, Preschool
• Female
• Humans
• Hypnotics and Sedatives (therapeutic use)
• Iatrogenic Disease (epidemiology, prevention & control)
• Infant
• Intensive Care Units, Pediatric (statistics & numerical data)
• Intubation, Intratracheal (adverse effects, instrumentation, methods)
• Laryngeal Diseases (diagnosis, epidemiology, etiology)
• Laryngoscopy (methods)
• Larynx (diagnostic imaging, injuries)
• Male
• Prosthesis Fitting (adverse effects)
• Respiration, Artificial (methods)
• Risk Factors