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

作者：Manica Denise^*; Saleh Netto Catia de Souza; Schweiger Claudia; Sekine Leo; Eneas Larissa Valency; Pereira Denise Rotta; Kuhl Gabriel; Antonacci Carvalho Paulo Roberto; Cauduro Marostica Paulo Jose

来源：European Archives of Oto-Rhino-Laryngology, 2017, 274(7): 2871-2876.

DOI：10.1007/s00405-017-4574-z

• Intubation
• Laryngoscopy
• Laryngostenosis
• Artificial ventilation

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.

• 出版日期2017-7