Department for Paediatric Anaesthesia, Children's Hospital, Amsterdamer Str. 59, 50735, Cologne, Germany.
Faculty for Health, University Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
Eur Arch Otorhinolaryngol. 2019 Dec;276(12):3419-3424. doi: 10.1007/s00405-019-05642-y. Epub 2019 Sep 17.
Surgical treatment is generally recommended for severe subglottic lesions following traumatic endotracheal intubation in children. An alternative approach is early transglottic corticosteroid administration to reduce scar formation and prevent the need for subsequent surgical intervention. This technique has been practiced successfully for several decades at the Children's Hospital of Cologne and the outcomes of 26 subsequent patients reviewed in this analysis.
All patients who underwent transglottic corticosteroid injection for treatment of post-intubation stridor and dyspnoea between 2012 and 2018 were identified and their records and endoscopy images analysed. Severity of the endoscopic findings was assessed using the Myer-Cotton classification (MCC) and an Expected Need for Surgical Intervention (ENSI) score (1 = inevitable; 2 = very likely necessary; 3 = probably avoidable and 4 = most likely not necessary) was recorded. Treatment was considered successful if the children had a complete resolution of clinical symptoms.
A total of 26 patients with a median (range) age of 1.9 (0.02-7.2) years and weight of 9.8 (1.8-25) kg were identified and included into the analysis. Endoscopic images were available for 22 children. All children underwent transglottic corticosteroid injection prior to any potential surgical treatment. A total of 22 patients (85%) improved following transglottic corticosteroid injection including 4 of 5 patients with a MCC = 3 and ENSI = 1 avoiding surgical intervention. None of the patients experienced a deterioration of clinical symptoms or endoscopic findings.
Transglottic corticosteroid injections as first-line treatment in children with severe post-endotracheal intubation trauma can successfully resolve symptoms and prevent invasive surgery.
对于儿童因气管插管创伤导致的严重声门下损伤，一般推荐手术治疗。另一种方法是早期经声带给予皮质类固醇，以减少疤痕形成并防止后续需要手术干预。该技术在科隆儿童医院已成功应用数十年，本分析回顾了 26 例随后患者的治疗结果。
我们确定了 2012 年至 2018 年间因气管插管后出现喘鸣和呼吸困难而接受经声带皮质类固醇注射治疗的所有患者，并对其记录和内镜图像进行了分析。使用 Myer-Cotton 分类（MCC）和预计需要手术干预（ENSI）评分评估内镜检查结果的严重程度（1=不可避免；2=极有可能需要；3=可能避免；4=极不可能需要）。如果患儿的临床症状完全缓解，则认为治疗成功。
共纳入 26 例年龄中位数（范围）为 1.9（0.02-7.2）岁，体重中位数（范围）为 9.8（1.8-25）kg 的患者，并进行了分析。22 例患儿有内镜图像资料。所有患儿均在接受任何潜在手术治疗之前接受了经声带皮质类固醇注射。22 例（85%）患儿在经声带皮质类固醇注射后症状得到改善，包括 5 例 MCC=3 和 ENSI=1 的患儿避免了手术干预。无一例患儿出现临床症状或内镜检查结果恶化。
对于严重气管插管创伤后儿童，经声带皮质类固醇注射作为一线治疗方法可成功缓解症状并防止侵入性手术。
