Jang Minyoung, Basa Krystyne, Levi Jessica
Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Int J Pediatr Otorhinolaryngol. 2018 Apr;107:45-52. doi: 10.1016/j.ijporl.2018.01.008. Epub 2018 Jan 31.
Intubation has been associated with laryngeal injury that often resolves spontaneously without complication. We present a case of a child intubated for less than 48 hours, who presented with dysphonia and intermittent dyspnea two months after intubation due to epiglottic and vocal process granulomas. This is unusual in that multiple granulomas were found in the posterior glottis and supraglottis after short-term intubation. Our objective was to determine if there are risk factors for developing persistent post-intubation sequelae, including the delayed presentation and unusual location of post-intubation granulomas in our case.
Case report and systematic literature review.
Pubmed database, which is inclusive of MEDLINE, was used to perform a literature review with the search terms ((pediatric OR children OR neonatal OR infant) AND (laryngeal OR supraglottic) AND intubation AND (granuloma OR injury OR complication)). Only English language results were reviewed. Titles and abstracts from 379 results were reviewed. Full text was reviewed from all original studies which included human pediatric subjects and endoscopic examinations after endotracheal intubation.
In our case, laryngeal granuloma size reduced significantly after starting anti-reflux medications. The remainder was removed with laryngeal microdebrider with no recurrence at 3 weeks and 2.5 years post-operatively. Overall, 28 of the 379 studies reviewed identified evidence of laryngeal trauma due to intubation, however only 6 studies documented any type of supraglottic injury. Risk factors identified for developing post-intubation sequelae included intubation duration greater than 24 h; trauma to the larynx via various mechanisms including traumatic intubation, need for reintubation and tube changes, and increased movement while intubated; and presence of respiratory tract infection during intubation.
Trauma to the larynx during intubation should be avoided to minimize post-intubation injury in pediatric patients, by using appropriate intubation protocols, endotracheal tube size, and adequate sedation.
气管插管与喉部损伤有关，这种损伤通常会自行缓解且无并发症。我们报告一例插管时间不到48小时的儿童病例，该患儿在插管后两个月因会厌和声突肉芽肿出现声音嘶哑和间歇性呼吸困难。这一情况不同寻常之处在于，短期插管后在声门后部和声门上发现了多个肉芽肿。我们的目的是确定是否存在发生持续性插管后后遗症的危险因素，包括我们病例中插管后肉芽肿的延迟出现和不寻常位置。
病例报告和系统文献综述。
使用包含MEDLINE的PubMed数据库进行文献综述，检索词为（（儿科或儿童或新生儿或婴儿）且（喉部或声门上）且插管且（肉芽肿或损伤或并发症））。仅审查英文结果。对379条结果的标题和摘要进行了审查。对所有纳入人类儿科受试者和气管插管后内镜检查的原始研究的全文进行了审查。
在我们的病例中，开始使用抗反流药物后，喉部肉芽肿大小显著减小。其余部分通过喉部微型清创器切除，术后3周和2.5年无复发。总体而言，在审查的379项研究中，有28项确定了插管导致喉部创伤的证据，但只有6项研究记录了任何类型的声门上损伤。确定的发生插管后后遗症的危险因素包括插管持续时间超过24小时；通过各种机制导致的喉部创伤，包括创伤性插管、再次插管和更换导管的需要以及插管时活动增加；以及插管期间存在呼吸道感染。
应通过使用适当的插管方案、气管导管尺寸和充分的镇静，避免插管期间对喉部造成创伤，以尽量减少儿科患者的插管后损伤。
