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Revista de otorrinolaringología y cirugía de cabeza y cuello

versión On-line ISSN 0718-4816

Resumen

ALVO V, Andrés  y  SEDANO M, Cecilia. Prevention, diagnosis and management of acute and subacute laryngotracheal post-intubation lesions in pediatric patients. Rev. Otorrinolaringol. Cir. Cabeza Cuello [online]. 2017, vol.77, n.1, pp.91-98. ISSN 0718-4816.  http://dx.doi.org/10.4067/S0718-48162017000100014.

Intubation-associated laryngotracheal injuries are mainly caused by a defective technique and endotracheal tube pressure-induced mucosal damage; patient factors and nursing care are also important. Up to 40% of intubated pediatric patients may show immediate laryngeal alterations and up to 30% have post-extubation stridor or dyspnea. If these symptoms last for over 3 days, laryngotracheoscopy is indicated. Edema, ulcers and granulation tissue are the most usual lesions. Edema can lead to acute airway obstruction, and is managed by reintubation with a smaller tube and topical application of a corticosteroid and antibiotic cream. Ulcers and granulations can lead to scarring that compromise laryngotracheal physiology; exophytic granulations must be removed endoscopically. Although the incidence of post-intubation subglottic stenosis has diminished over the last decades to about2,7% to 4,2%, some studies suggest that there is a subdiagnosis because of oligosymptomatic lesions at the time of discharge. On the active scarring period, dilatation of the stenosis can be used to avoid open surgery. Early otorhinolaryngologic management of these patients is fundamental for avoiding irreversible cicatricial sequels that require complex surgeries, with life risk due to airway obstruction.

Palabras clave : Subglottic stenosis; Intubation; Laryngotracheoscopy.

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