Management and prevention of endotracheal intubation injury in neonates. 2011

Julie L Wei, and Justin Bond
Department of Otolaryngology-Head Neck Surgery, Kansas City, Kansas 66160, USA. jwei@kumc.edu

OBJECTIVE To summarize the diagnosis, pathology, and management of glottic, subglottic, and tracheal injuries secondary to endotracheal intubation in neonates. RESULTS Published reports of intubation-related injuries include laryngeal stenosis, subglottic stenosis (SGS), tracheal rupture, subglottic cysts, and pharyngoesophageal perforation. Such injuries are multifactorial, with risk factors including patient size and weight, use of cuffed versus uncuffed endotracheal tubes, and fragility of the mucosa. In addition, the skill and awareness of the person performing the intubation may also influence risk of intubation-related injuries. Studies on fetal cricoid anatomy demonstrate differences in the configuration of cricoids lumen between premature infants and the adult larynx. Most recently reported airway injuries due to intubation have history of prematurity as a common risk factor, with increasing incidence associated with decreasing gestational age and weight. Prematurity and prolonged intubations remain the top risk factors for development of subglottic cysts. Management of above-mentioned complications includes endoscopy versus open laryngotracheoplasty for SGS, using balloon or traditional dilatation or augmentation with cartilage grafts, respectively; bridging injured area with endotracheal tube versus open resection and primary closure for tracheal rupture; and use of laser or cold techniques for removal of cysts. CONCLUSIONS Although intubation-related injuries may occur in anyone, neonates are at increased risk due to their small airway lumen and cricoids cartilage morphology. Endoscopic and open reconstructive techniques increase treatment options to treat glottic and SGS.

UI MeSH Term Description Entries
D007049 Iatrogenic Disease Any adverse condition in a patient occurring as the result of treatment by a physician, surgeon, or other health professional, especially infections acquired by a patient during the course of treatment. Hospital-Acquired Condition,Condition, Hospital-Acquired,Conditions, Hospital-Acquired,Disease, Iatrogenic,Diseases, Iatrogenic,Hospital Acquired Condition,Hospital-Acquired Conditions,Iatrogenic Diseases
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D007234 Infant, Premature A human infant born before 37 weeks of GESTATION. Neonatal Prematurity,Premature Infants,Preterm Infants,Infant, Preterm,Infants, Premature,Infants, Preterm,Premature Infant,Prematurity, Neonatal,Preterm Infant
D007442 Intubation, Intratracheal A procedure involving placement of a tube into the trachea through the mouth or nose in order to provide a patient with oxygen and anesthesia. Intubation, Endotracheal,Endotracheal Intubation,Endotracheal Intubations,Intratracheal Intubation,Intratracheal Intubations,Intubations, Endotracheal,Intubations, Intratracheal
D007818 Laryngeal Diseases Pathological processes involving any part of the LARYNX which coordinates many functions such as voice production, breathing, swallowing, and coughing. Laryngeal Perichondritis,Larynx Diseases,Disease, Laryngeal,Disease, Larynx,Diseases, Laryngeal,Diseases, Larynx,Laryngeal Disease,Laryngeal Perichondritides,Larynx Disease,Perichondritides, Laryngeal,Perichondritis, Laryngeal
D007828 Laryngoscopy Examination, therapy or surgery of the interior of the larynx performed with a specially designed endoscope. Laryngoscopic Surgical Procedures,Surgical Procedures, Laryngoscopic,Laryngoscopic Surgery,Surgery, Laryngoscopic,Laryngoscopic Surgeries,Laryngoscopic Surgical Procedure,Laryngoscopies,Procedure, Laryngoscopic Surgical,Procedures, Laryngoscopic Surgical,Surgeries, Laryngoscopic,Surgical Procedure, Laryngoscopic
D002404 Catheterization Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from INTUBATION in that the tube here is used to restore or maintain patency in obstructions. Cannulation,Cannulations,Catheterizations
D002983 Clinical Competence The capability to perform acceptably those duties directly related to patient care. Clinical Skills,Competence, Clinical,Clinical Competency,Clinical Skill,Competency, Clinical,Skill, Clinical,Skills, Clinical,Clinical Competencies,Competencies, Clinical
D003413 Cricoid Cartilage The small thick cartilage that forms the lower and posterior parts of the laryngeal wall. Cartilage, Cricoid,Cartilages, Cricoid,Cricoid Cartilages
D005931 Glottis The vocal apparatus of the larynx, situated in the middle section of the larynx. Glottis consists of the VOCAL FOLDS and an opening (rima glottidis) between the folds. Rima Glottidis,Glottidi, Rima,Glottidis, Rima,Rima Glottidi

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