Bibl Katharina, Pracher Lena, Küng Erik, Wagner Michael, Roesner Imme, Berger Angelika, Hermon Michael, Werther Tobias
Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.
Front Pediatr. 2022 May 11;10:864766. doi: 10.3389/fped.2022.864766. eCollection 2022.
Endotracheal intubation is a common procedure in Neonatal Intensive Care. While cuffed endotracheal tubes (ETT) are the standard of care in adults and children, their use in infants is controversial. The aim of this study was to compare the incidence of post-extubation stridor between uncuffed and cuffed ETTs in infants. We further evaluated the safety of cuffed ETTs in infants with a bodyweight between 2 and 3 kg and performed baseline analysis on development of subglottic stenosis.
In this retrospective study, we screened all infants admitted to two NICUs of the Medical University of Vienna between 2012 and 2019.The study cohort was screened twice: In the first screening we selected all infants who underwent the first intubation when attaining a bodyweight >2 kg (but <6 kg) to analyze the incidence of post-extubation stridor and only considered the first intubation of each included infant. Post-extubation stridor was defined as the administration of either epinephrine aerosol or any corticosteroid within 6 h post-extubation. In the second screening we searched for all infants diagnosed with acquired severe subglottic stenosis during the study period regardless their bodyweight and numbers of intubations.
A total of 389 infants received at least one intubation during the study period. After excluding infants who underwent the first intubation below a bodyweight of 2 kg, 271 infants remained for final analysis with an average gestational age of 38.7 weeks at the time of intubation. Among those, 92 (33.9%) were intubated with a cuffed and 179 (66.1%) with an uncuffed ETT. Seven infants (2.6%) developed a clinically significant stridor: five of those were intubated with a cuffed and two with an uncuffed ETT (71.4 vs. 28.6%, = 0.053). All of them had a bodyweight >3 kg at the time of intubation. Infants who developed subglottic stenosis were more often intubated with an uncuffed ETT.
In this study, no difference in the incidence of post-extubation stridor between cuffed and uncuffed ETTs in infants with a bodyweight from 2 to 6 kg could be found. The use of uncuffed ETTs does not exhibit higher risk for the acquired subglottic stenosis in this cohort.
气管插管是新生儿重症监护中的常见操作。虽然带套囊气管内导管（ETT）是成人和儿童的护理标准，但在婴儿中的使用存在争议。本研究的目的是比较婴儿中无套囊和带套囊ETT拔管后喘鸣的发生率。我们进一步评估了体重在2至3千克之间的婴儿使用带套囊ETT的安全性，并对声门下狭窄的发展进行了基线分析。
在这项回顾性研究中，我们筛查了2012年至2019年间维也纳医科大学两个新生儿重症监护病房收治的所有婴儿。该研究队列进行了两次筛查：在第一次筛查中，我们选择了所有体重>2千克（但<6千克）时接受首次插管的婴儿，以分析拔管后喘鸣的发生率，并且只考虑每个纳入婴儿的首次插管。拔管后喘鸣定义为在拔管后6小时内给予肾上腺素气雾剂或任何皮质类固醇。在第二次筛查中，我们搜索了研究期间所有被诊断为获得性严重声门下狭窄的婴儿，无论其体重和插管次数。
在研究期间，共有389名婴儿接受了至少一次插管。在排除体重低于2千克时接受首次插管的婴儿后，剩下271名婴儿进行最终分析，插管时的平均胎龄为38.7周。其中，92名（33.9%）使用带套囊ETT插管，179名（66.1%）使用无套囊ETT插管。7名婴儿（2.6%）出现了临床上显著的喘鸣：其中5名使用带套囊ETT插管，2名使用无套囊ETT插管（71.4%对28.6%，P = 0.053）。他们在插管时体重均>3千克。出现声门下狭窄的婴儿更常使用无套囊ETT插管。
在本研究中，未发现体重在2至6千克的婴儿中，带套囊和无套囊ETT拔管后喘鸣的发生率存在差异。在该队列中，使用无套囊ETT不会增加获得性声门下狭窄的风险。
