Flexible fiber-optic laryngoscopy in the first hours after extubation for the evaluation of laryngeal lesions due to intubation in the pediatric intensive care unit

• Published in: International journal of pediatric otorhinolaryngology Vol. 71; no. 9; pp. 1423 - 1428
• Main Authors: Smith, Mariana Magnus, Kuhl, Gabriel, Carvalho, Paulo Roberto Antonacci, Marostica, Paulo José Cauduro
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01-09-2007
• Subjects: Bradycardia - epidemiology; Child; Child, Preschool; Craniofacial Abnormalities - epidemiology; Craniofacial Abnormalities - surgery; Female; Fiber Optic Technology - instrumentation; Fiber-optic laryngoscopy; Granuloma, Laryngeal - epidemiology; Granuloma, Laryngeal - pathology; Humans; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Intubation - adverse effects; Intubation - statistics & numerical data; Laryngeal lesion; Laryngoscopy; Laryngoscopy - methods; Larynx - injuries; Male; Mechanical ventilation; Optical Fibers; Otolaryngology; Pediatrics; Prognosis; Tracheal intubation; Tracheostomy; Wounds and Injuries - diagnosis; Wounds and Injuries - epidemiology; Wounds and Injuries - etiology; Laryngeal lesion; Fiber-optic laryngoscopy; Child; Mechanical ventilation; Tracheal intubation; Laryngoscopy
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2007.05.016

Summary Objective To evaluate the feasibility and safety of using fiber-optic laryngoscopy in the first hours after extubation for the early diagnosis of laryngeal lesions in infants and children in the pediatric intensive care unit and describe the findings of such approach. Methods Patients 0–4 years old who had undergone endotracheal intubation for longer than 24 h were included in the study. Exclusion criteria were history of laryngeal symptoms, current intubation or tracheostomy, craniofacial malformations, or a poor prognosis according to the medical team responsible for the patient. Exams were performed in the pediatric intensive care unit in the first 8 h after extubation; the patient was at the bedside and did not receive sedation. The fiber-optic laryngoscope was used to obtain images of the larynx. Minor complications were: saturation decrease not below 85% and rapid recovery, and minor nasal bleeding. Severe complications were: bradycardia and laryngospasm that required intervention. Images were evaluated by a blinded examiner, and findings were classified as mild and unspecific (edema and hyperemia), or specific, such as laryngomalacia and glottic granulation and subglottic ulceration and granulation. Results were expressed as means and standard deviations when the variable had a normal distribution, and as median and interquartile ranges for asymmetric data. Results Forty-one patients, mean age 2.7 months (interquartile range 1.5–6.1), were included in the study. Fiber-optic laryngoscopy was performed between 40 min and 8 h after extubation, and mean time was 4.9 h (standard deviation = 2.4 h). Mean exam duration was 4.16 min (2.41–7.12 min; standard deviation = 1 min). One patient (2.4%) had mild desaturation, a minor complication. No other complications were found. Thirty-five patients were available to 6-month follow-up and subglottic stenosis was found in 11.4%. Conclusions Fiber-optic laryngoscopy may be safely performed in the first hours after extubation, with few minor complications. It does not take long, but provides accurate information about the conditions of the supraglottic and glottic larynx. The subglottic region can also be visualized in most patients. This easily performed exam seems to be useful for the diagnosis of pediatric patients with acute laryngeal lesions due to intubation.