Bhartendu Bharthi, (2013) Post-intubation laryngeal injuries in a paediatric intensive care unit of tertiary hospital in India: A fibreoptic endoscopic study. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: In current medical practice, critical care technology and assisted ventilation have grown immensely over the past few decades. Critically ill patients are treated with prolonged assisted ventilation. Intubation is a routine procedure in such patients, and it might take several weeks either to extubate or tracheotomise these patients. Laryngotracheal intubation in adults was first done around 1878 by a British surgeon, William McEwen, who used a brass fashioned tube for orotracheal intubation. By 1910’s, O’Dwyer, Elsborg, and several others contributed to making it acceptable for induction of anaesthesia. It was Bergstorm who first provided prolonged intubation for comatose patients due to head injury or poisoning in 1962. Paediatric intubations, however, were considered unsafe and were not in practice till the 1930’s. Subsequent advancements in anaesthesiology in the 1940’s made paediatric intubation more acceptable. AIMS AND OBJECTIVES: 1. To identify acute laryngeal injuries in paediatric patients intubated for more than 48 hours. 2. To correlate these injuries with age of child, size and type of tube, skill level of the intubator and duration of intubation. MATERIALS AND METHODS: Children who underwent endotracheal intubation from 1st September 2011 to 30th November 2012 were included in the study. Parents or caregivers of children who underwent intubation as an emergency, semi-elective or elective procedure, and were admitted in the Paediatric Intensive Care Unit for 48 hours or more, were invited to participate in the study. Informed consent was obtained from the parent or guardian when extubation was planned. Patient selection criteria: Inclusion Criteria: Children who were admitted to the Paediatric ICU with • endotracheal tube in situ for more than 48 hours. • Age 1-15 years. • Consent from the parent or guardian to participate in the study. Exclusion criteria - presence of any of the following conditions: • Congenital abnormality of the respiratory tract. • Thyroid surgery, cardiothoracic surgery, and/or neck trauma. • Needing oxygen therapy of fio2 > 60%. • Extubation to NPCPAP/high flow oxygen therapy. • Requiring more than one ionotrope. • Respiratory Rate > 2 SD above normal for age. • HR> 2 SD above normal for age. • Platelet count < 50,000/cu.mm. • Evidence for coagulopathy (INR> 1.5). • Head injury (possibility of ICP still being high). • Acute neuroinfections/ status seizures if GCS < 10. • Any other in the opinion of the ICU senior consultant felt to be unfit for procedure. CONCLUSION: In our study of 34 paediatric patients intubated for more than 48 hours. • 97% had acute laryngeal injury, of which 88% was significant. • Erythema was the most common form of injury (97%). • Duration of intubation (mean 4.5 days) shows a trend towards subglottic narrowing (p value-0.06). • Laryngeal injuries were similar in both cuffed and uncuffed tubes. • Age, size of the tube and skill level of the intubator did not correlate with the laryngeal injuries. • 18% required intervention for post-extubation significant oedema. • Three children (10%) had post-extubation stridor; two out of the three (6% of the total) children needed surgical intervention.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Post-intubation laryngeal injuries, paediatric intensive care unit (PICU), tertiary hospital, India, fibreoptic endoscopic study. |
| Subjects: | MEDICAL > Otolaryngology |
| Depositing User: | Devi S |
| Date Deposited: | 27 Mar 2020 06:21 |
| Last Modified: | 27 Mar 2020 06:21 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12480 |
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