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. 2024 May-Jun;90(3):101401.
doi: 10.1016/j.bjorl.2024.101401. Epub 2024 Feb 22.

Position paper of diagnosis and treatment of post-extubation laryngitis in children: a multidisciplinary expert-based opinion

Débora Bressan Pazinatto  1 , Rebecca Maunsell  2 , Melissa Ameloti Gomes Avelino  3 , Jose Faibes Lubianca Neto  4 , Cláudia Schweiger  5 , Jamil Pedro de Siqueira Caldas  6 , Marcelo Barciela Brandão  2 , Paula Pires de Souza  3 , Fernanda Aparecida de Oliveira Peixoto  3 , Claudia Pires Ricachinevsky  4 , Rita C Silveira  5 , Cinara Andreolio  5 , Carolina Sponchiado Miura  7 , Daniele da Silva Jordan Volpe  7 , Walusa Assad Gonçalves Ferri  7 , Fabiano Bleggi Gavazzoni  8 , Paulo Ramos David João  8 , Silmara Aparecida Possas  8 , Carlos Takahiro Chone  2
Affiliations

Position paper of diagnosis and treatment of post-extubation laryngitis in children: a multidisciplinary expert-based opinion

Débora Bressan Pazinatto et al. Braz J Otorhinolaryngol. 2024 May-Jun.

Abstract

Objectives: To make recommendations on the diagnosis and treatment of post-extubation laryngitis (PEL) in children with or without other comorbidities.

Methods: A three-iterative modified Delphi method was applied. Specialists were recruited representing pediatric otolaryngologists, pediatric and neonatal intensivists. Questions and statements approached topics encompassing definition, diagnosis, endoscopic airway evaluation, risk factors, comorbidities, management, and follow-up. A consensus was defined as a supermajority >70%.

Results: Stridor was considered the most frequent symptom and airway endoscopy was recommended for definitive diagnosis. Gastroesophageal reflux and previous history of intubation were considered risk factors. Specific length of intubation did not achieve a consensus as a risk factor. Systemic corticosteroids should be part of the medical treatment and dexamethasone was the drug of choice. No consensus was achieved regarding dosage of corticosteroids, although endoscopic findings help defining dosage and length of treatment. Non-invasive ventilation, laryngeal rest, and use of comfort sedation scales were recommended. Indications for microlaryngoscopy and bronchoscopy under anesthesia were symptoms progression or failure to improve after the first 72-h of medical treatment post-extubation, after two failed extubations, and/or suspicion of severe lesions on flexible fiberoptic laryngoscopy.

Conclusions: Management of post-extubation laryngitis is challenging and can be facilitated by a multidisciplinary approach. Airway endoscopy is mandatory and impacts decision-making, although there is no consensus regarding dosage and length of treatment.

Keywords: Acute lesions; Intubation; Larynx; Pediatrics; Subglottic stenosis.

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Figures

Figure 1
Figure 1
Flowchart indicating the need of endoscopic airway evaluation in the intubated child. Figure authorized by the authors.
See this image and copyright information in PMC

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