Incidence and endoscopic characteristics of acute laryngeal lesions in children undergoing endotracheal intubation

Eliandra da Silveira de Lima, Maíra Alves Braga de Oliveira, Carolina Rocha Barone, Kharina Mayara Moreira Dias, Samanta Daiana de Rossi, Claudia Schweiger, Denise Manica, Larissa Valency Enéas, Catia de Souza Saleh Netto, Gabriel Kuhl, Paulo Roberto Antonacci Carvalho, Paulo Jose Cauduro Marostica

Acute laryngeal lesions after intubation appear to be precursors of chronic lesions. To describe the incidence and type of acute laryngeal lesions after extubation in a pediatric intensive care unit (PICU). A cohort study involving children from birth to <5 years, submitted to intubation for more than 24h in the PICU of an university hospital. In the first eight hours after extubation, a flexible fiberoptic laryngoscopy (FFL) was performed at the bedside. Those with moderate to severe abnormalities underwent a second examination seven to ten days later. 177 patients were included, with a median age of 2.46 months. The mean intubation time was 8.19 days. Seventy-three (41.2%) patients had moderate or severe alterations at the FFL, with the remaining showing only minor alterations or normal results. During follow-up, 16 children from the group with moderate to severe lesions developed subglottic stenosis. One patient from the normal FFL group had subglottic stenosis, resulting in an incidence of 9.6% of chronic lesions. Most children in the study developed mild acute laryngeal lesions caused by endotracheal intubation, which improved in a few days after extubation.