Early dilatation of acquired post-intubation subglottic stenosis using endotracheal tubes

Abstract

Introduction: Acquired post-intubation subglottic stenosis is one of the most important complications causing persistent stridor after endotracheal intubation. Early diagnosis and management can lead to less-invasive procedures with high success rates. If the acute post-intubation injuries progress into a stenosis, endoscopic dilatations can be attempted to reestablish an adequate lumen. These can be performed using blunt instrument or balloons. Balloons are effective but expensive, and obstruct the airway while dilatating. Aim: Present our experience with progressive blunt dilatation of acquired post-intu- bation subglottic stenosis using endotracheal tubes. Material and method: Retrospective chart review of dilatations performed as the primary treatment in early acquired pediatric subglottic stenosis. Results: 16 patients with grades I to III stenosis were included. Average age was 2 years 4 months, and average intubation time was 6.6 days. The number of procedures ranged between 1 and 6, with a mean of 2. Clinical success was achieved in all patients, with resolution of respiratory symptoms and avoidance of tracheostomy. There were no complications or mortality. Conclusion: In this cohort, subglottic dilatation using endotracheal tubes was effec- tive and safe. Endotracheal tubes are easily available and allow to ventilate the patient while performing the procedure.