Endoscopic Screening for Laryngotracheal Complications in Children Following Prolonged Mechanical Ventilation Maintained Through Endotracheal Intubation: A Cross-Sectional Pilot Project

Mainak Dutta; Debjit Jana; Diptanshu Mukherjee; Tanaya Panja; Amit Kumar Shukla; Divya Daga; Krishna Kumar Yadav; Swarnali Mondal; Saumendra Nath Bandyopadhyay

doi:10.1177/00034894241308411

Endoscopic Screening for Laryngotracheal Complications in Children Following Prolonged Mechanical Ventilation Maintained Through Endotracheal Intubation: A Cross-Sectional Pilot Project

Ann Otol Rhinol Laryngol. 2024 Dec 25:34894241308411. doi: 10.1177/00034894241308411. Online ahead of print.

Authors

Mainak Dutta¹, Debjit Jana², Diptanshu Mukherjee², Tanaya Panja², Amit Kumar Shukla², Divya Daga², Krishna Kumar Yadav², Swarnali Mondal², Saumendra Nath Bandyopadhyay²

Affiliations

¹ Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, Kalyani; Basantapur, Saguna, Nadia, West Bengal, India.
² Department of Otorhinolaryngology & Head-Neck Surgery, Medical College & Hospital, Kolkata; West Bengal, India.

PMID: 39720852
DOI: 10.1177/00034894241308411

Abstract

Background: An endoscopic screening program following successful weaning from prolonged mechanical ventilation maintained through endotracheal tube (ET; prolonged intubation) may be justified to assess the upper (laryngotracheal) airway in children who may not always be symptomatic for intubation-related complications.

Objectives: To evaluate effects of prolonged intubation in children through endoscopic screening of the laryngotracheal airway.

Methods: In this cross-sectional pilot project, children (2 months-12 years) successfully extubated following prolonged intubation were selected, irrespective of having symptoms, for a 1-time flexible nasolaryngoscopy at third to sixth month post-extubation (follow-up window). Laryngotracheal airway changes, if present, were noted.

Results: Out of 122 children, 42 developed symptoms of complications. Five of them attended within 3 months post-extubation, the rest were evaluated in the follow-up window. Eighty children aged ≤6 years and 4 children >6 years were intubated with uncuffed ET. Symptoms, when present, included respiratory distress (100%), noisy breathing (~36%), cough (~29%), and dysphagia (~12%). Screening revealed positive findings in 40 out of 42 symptomatic children, and in 8 out of 80 asymptomatic children (χ² = 80.314; after Yate's correction; significant at P < .0001). The commonest lesion was subglottic stenosis (~54%) and intubation granuloma (~48%). Relationship between the nature of ET (cuffed/uncuffed) and complications of prolonged intubation was statistically significant (χ²46.553; significant at P < .0001).

Conclusion: The present study proposes the potential utility of follow-up endoscopic screening of upper (laryngotracheal) airway in children successfully weaned from prolonged intubation. A statistically significant relationship existed between prolonged intubation and upper airway complications that were not always symptomatic.

Keywords: arytenoid granuloma; complications; endotracheal tube; laryngotracheal; pediatric; pediatric intensive care unit; prolonged intubation; prolonged mechanical ventilation; subglottic stenosis; upper airway.