Management and prevention of endotracheal intubation injury in neonates

Abstract

Purpose of review: To summarize the diagnosis, pathology, and management of glottic, subglottic, and tracheal injuries secondary to endotracheal intubation in neonates.

Recent findings: Published reports of intubation-related injuries include laryngeal stenosis, subglottic stenosis (SGS), tracheal rupture, subglottic cysts, and pharyngoesophageal perforation. Such injuries are multifactorial, with risk factors including patient size and weight, use of cuffed versus uncuffed endotracheal tubes, and fragility of the mucosa. In addition, the skill and awareness of the person performing the intubation may also influence risk of intubation-related injuries. Studies on fetal cricoid anatomy demonstrate differences in the configuration of cricoids lumen between premature infants and the adult larynx. Most recently reported airway injuries due to intubation have history of prematurity as a common risk factor, with increasing incidence associated with decreasing gestational age and weight. Prematurity and prolonged intubations remain the top risk factors for development of subglottic cysts. Management of above-mentioned complications includes endoscopy versus open laryngotracheoplasty for SGS, using balloon or traditional dilatation or augmentation with cartilage grafts, respectively; bridging injured area with endotracheal tube versus open resection and primary closure for tracheal rupture; and use of laser or cold techniques for removal of cysts.

Summary: Although intubation-related injuries may occur in anyone, neonates are at increased risk due to their small airway lumen and cricoids cartilage morphology. Endoscopic and open reconstructive techniques increase treatment options to treat glottic and SGS.