Hospital de Clínicas de Porto Alegre, Serviço de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
J Pediatr (Rio J). 2020 Jan-Feb;96(1):39-45. doi: 10.1016/j.jped.2018.08.004. Epub 2018 Sep 21.
To assess the accuracy of stridor in comparison to endoscopic examination for diagnosis of pediatric post-intubation subglottic stenosis.
Children who required endotracheal intubation for >24h were included in this prospective cohort study. Children were monitored daily and underwent flexible fiberoptic laryngoscopy after extubation. Those with moderate-to-severe abnormalities underwent another examination 7-10 days later. If lesions persisted or symptoms developed, laryngoscopy under general anesthesia was performed. Patients were assessed daily for stridor after extubation.
A total of 187 children were included. The incidence of post-extubation stridor was 44.38%. Stridor had a sensitivity of 77.78% (95% confidence interval [95% CI]: 51.9-92.6) and specificity of 59.18% (95% CI: 51.3-66.6) in detecting subglottic stenosis. The positive predictive value was 16.87% (95% CI: 9.8-27.1), and the negative predictive value was 96.15% (95% CI: 89.9-98.8). Stridor persisting longer than 72h or starting more than 72h post-extubation had a sensitivity of 66.67% (95% CI: 41.2-85.6), specificity of 89.1% (95% CI: 83.1-93.2), positive predictive value of 40.0% (95% CI: 23.2-59.3), and negative predictive value of 96.07% (95% CI: 91.3-98.4). The area under the receiver operating characteristic (ROC) curve was 0.78 (95% CI: 0.65-0.91).
Absence of stridor was appropriate to rule out post-intubation subglottic stenosis. The specificity of this criterion improved when stridor persisted longer than 72h or started more than 72h post-extubation. Thus, endoscopy under general anesthesia can be used to confirm subglottic stenosis only in patients who develop or persist with stridor for more than 72h following extubation.
评估喘鸣与内镜检查在诊断小儿气管插管后声门下狭窄中的准确性。
本前瞻性队列研究纳入了需要气管插管超过 24 小时的儿童。儿童在拔管后每天进行监测，并进行纤维喉镜检查。对于中度至重度异常的患者，在 7-10 天后进行另一项检查。如果病变持续或出现症状，则进行全身麻醉下的喉镜检查。拔管后，每天评估患者的喘鸣情况。
共纳入 187 名儿童。拔管后喘鸣的发生率为 44.38%。喘鸣对声门下狭窄的敏感性为 77.78%（95%可信区间[95%CI]：51.9-92.6），特异性为 59.18%（95%CI：51.3-66.6）。阳性预测值为 16.87%（95%CI：9.8-27.1），阴性预测值为 96.15%（95%CI：89.9-98.8）。持续时间超过 72 小时或拔管后 72 小时以上开始的喘鸣的敏感性为 66.67%（95%CI：41.2-85.6），特异性为 89.1%（95%CI：83.1-93.2），阳性预测值为 40.0%（95%CI：23.2-59.3），阴性预测值为 96.07%（95%CI：91.3-98.4）。接收器工作特征（ROC）曲线下面积为 0.78（95%CI：0.65-0.91）。
无喘鸣可排除气管插管后声门下狭窄。当喘鸣持续时间超过 72 小时或拔管后 72 小时以上开始时，该标准的特异性提高。因此，仅在拔管后出现或持续喘鸣超过 72 小时的患者中，才可使用全身麻醉下的内镜检查来确诊声门下狭窄。
