Undersedation is a risk factor for the development of subglottic stenosis in intubated children☆, ☆☆

Schweiger, Cláudia; Manica, Denise; Pereira, Denise Rotta Rutkay; Carvalho, Paulo Roberto Antonacci; Piva, Jefferson Pedro; Kuhl, Gabriel; Sekine, Leo; Marostica, Paulo José Cauduro

doi:10.1016/j.jped.2016.10.006

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Original articles • J. Pediatr. (Rio J.) 93 (4) • Jul-Aug 2017 • https://doi.org/10.1016/j.jped.2016.10.006 copy

Undersedation is a risk factor for the development of subglottic stenosis in intubated children^☆ ☆ Please cite this article as: Schweiger C, Manica D, Pereira DR, Carvalho PR, Piva JP, Kuhl G, et al. Undersedation is a risk factor for the development of subglottic stenosis in intubated children. J Pediatr (Rio J). 2017;93:351-5. , ^☆☆ ☆☆ This study was performed in the Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Porto Alegre, RS, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the level of sedation in intubated children as a risk factor for the development of subglottic stenosis.

Methods:

All patients between 30 days and 5 years of age who required endotracheal intubation in the pediatric intensive care unit between 2013 and 2014 were included in this prospective study. They were monitored daily and COMFORT-B scores were obtained. Flexible fiber-optic laryngoscopy was performed within eight hours of extubation, and repeated seven to ten days later if the first examination showed moderate to severe laryngeal injuries. If these lesions persisted and/or if the child developed symptoms in the follow-up period, microlaryngoscopy under general anesthesia was performed to evaluate for subglottic stenosis.

Results:

The study included 36 children. Incidence of subglottic stenosis was 11.1%. Children with subglottic stenosis had a higher percentage of COMFORT-B scores between 23 and 30 (undersedated) than those who did not develop subglottic stenosis (15.8% vs. 3.65%, p = 0.004).

Conclusion:

Children who developed subglottic stenosis were less sedated than children who did not develop subglottic stenosis.

KEYWORDS
Larynx; Airway stenosis/reconstruction; Children

Variable	Distribution
Age (months)	2.6 (1.9-7.2)^a a Median (interquartile range, P25-P75).
Male sex (%)	18 (50.0%)^b b Number of patients (percentage).
Gestational age (weeks)	38.0 (35.2-39.0)^a a Median (interquartile range, P25-P75).
Attempted intubations	1.0 (1.0-2.0)^c c Median (range, minimum-maximum).
Reintubations/days intubated	0.0 (0.0-2.0)^c c Median (range, minimum-maximum).
Days intubated	6.0 (5.0-8.5)^a a Median (interquartile range, P25-P75).
Additional doses of sedation/days intubated	10.5 (4.3)^d d Mean (standard deviation).
Cuffed tube	10 (27.8%)^b b Number of patients (percentage).

Variable	No SGS (n = 32)	SGS (n = 4)	p
Male sex^a a Pearson's chi-squared.	17 (53.1%)^c c Number of patients (percentage).	1 (25.0%)^c c Number of patients (percentage).	0.29
Attempted intubations^b b Mann-Whitney U-test.	1 (1-2)^d d Median (range, minimum-maximum).	1 (1-1)^d d Median (range, minimum-maximum).	0.94
Days intubated^b b Mann-Whitney U-test.	6 (5.0-9.0)^e e Median (interquartile range, P25-P75).	6 (2.7-7.0)^e e Median (interquartile range, P25-P75).	0.61
Additional doses of sedation/days intubated^b b Mann-Whitney U-test.	9.9 (4.0)^f f Mean (standard deviation).	15.1 (4.3)^f f Mean (standard deviation).	0.05
Cuffed tube^a a Pearson's chi-squared.	9 (28.1%)^c c Number of patients (percentage).	1 (25.0%)^c c Number of patients (percentage).	0.89
Reintubations/days intubated^b b Mann-Whitney U-test.	0 (0-0.18)^d d Median (range, minimum-maximum).	0 (0-0.20)^d d Median (range, minimum-maximum).	0.68

Variable	SGS n = 4	Normal larynx n = 32	p
Mean COMFORT-B score	16.00 ± 1.76	12.76 ± 2.13	0.006
% of COMFORT-B scores between 23 and 30 (undersedated)	15.8%	3.65%	0.004
% of COMFORT B scores between 11 and 22 (adequately sedated)	58.25%	56.43%	0.511
% of COMFORT B scores between 6 and 10 (oversedated)	25.95%	39.92%	0.05

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E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail:causch@hotmail.com (C. Schweiger).