Undersedation is a risk factor for the development of subglottic stenosis in intubated children
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 thi...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2017-07-01
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| Series: | Jornal de Pediatria |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0021755717300402 |
| _version_ | 1817988200005632000 |
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| author | Cláudia Schweiger Denise Manica Denise Rotta Rutkay Pereira Paulo Roberto Antonacci Carvalho Jefferson Pedro Piva Gabriel Kuhl Leo Sekine Paulo José Cauduro Marostica |
| author_facet | Cláudia Schweiger Denise Manica Denise Rotta Rutkay Pereira Paulo Roberto Antonacci Carvalho Jefferson Pedro Piva Gabriel Kuhl Leo Sekine Paulo José Cauduro Marostica |
| author_sort | Cláudia Schweiger |
| collection | DOAJ |
| description | 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. Resumo: Objetivo: Analisar o nível de sedação em crianças intubadas como um fator de risco para o desenvolvimento de estenose subglótica (ES). Métodos: Todos os pacientes entre 30 dias e 5 anos de idades que necessitaram de intubação endotraqueal na Unidade de Terapia Intensiva Pediátrica entre 2013 e 2014 foram incluídos neste estudo prospectivo. Eles foram monitorados diariamente e foram obtidos os escores da escala COMFORT-B. Foi feita laringoscopia com tubo flexível de fibra óptica em 8 horas da extubação e repetida 7-10 dias depois, caso o primeiro exame tenha mostrado lesões laríngeas moderadas a graves. Caso essas lesões tenham persistido e/ou caso a criança tenha desenvolvido sintomas no período de acompanhamento, foi feita microlaringoscopia sob anestesia geral para avaliar a ES. Resultados: Incluímos 36 crianças. A incidência da ES foi de 11,1%. As crianças com ES apresentaram um maior percentual de escores da escala COMFORT-B entre 23 e 30 (subsedados) que os que não desenvolveram ES (15,8% em comparação a 3,65%, p = 0,004). Conclusão: As crianças que desenvolveram ES foram menos sedadas que as crianças que não desenvolveram ES. Keywords: Larynx, Airway stenosis/reconstruction, Children, Palavras-chave: Laringe, Estenose/Reconstrução das vias aéreas, Crianças |
| first_indexed | 2024-04-14T00:31:16Z |
| format | Article |
| id | doaj.art-b972246cb6674181834471495ff5a554 |
| institution | Directory Open Access Journal |
| issn | 0021-7557 |
| language | English |
| last_indexed | 2024-04-14T00:31:16Z |
| publishDate | 2017-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Jornal de Pediatria |
| spelling | doaj.art-b972246cb6674181834471495ff5a5542022-12-22T02:22:32ZengElsevierJornal de Pediatria0021-75572017-07-01934351355Undersedation is a risk factor for the development of subglottic stenosis in intubated childrenCláudia Schweiger0Denise Manica1Denise Rotta Rutkay Pereira2Paulo Roberto Antonacci Carvalho3Jefferson Pedro Piva4Gabriel Kuhl5Leo Sekine6Paulo José Cauduro Marostica7Hospital de Clínicas de Porto Alegre, Unidade de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Corresponding author.Hospital de Clínicas de Porto Alegre, Unidade de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, BrazilUniversidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, BrazilUniversidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Porto Alegre, RS, BrazilUniversidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Porto Alegre, RS, BrazilHospital de Clínicas de Porto Alegre, Unidade de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Otorrinolaringologia e Oftalmologia, Porto Alegre, RS, BrazilUniversidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, BrazilUniversidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Unidade de Pneumologia Pediátrica, Porto Alegre, RS, BrazilObjective: 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. Resumo: Objetivo: Analisar o nível de sedação em crianças intubadas como um fator de risco para o desenvolvimento de estenose subglótica (ES). Métodos: Todos os pacientes entre 30 dias e 5 anos de idades que necessitaram de intubação endotraqueal na Unidade de Terapia Intensiva Pediátrica entre 2013 e 2014 foram incluídos neste estudo prospectivo. Eles foram monitorados diariamente e foram obtidos os escores da escala COMFORT-B. Foi feita laringoscopia com tubo flexível de fibra óptica em 8 horas da extubação e repetida 7-10 dias depois, caso o primeiro exame tenha mostrado lesões laríngeas moderadas a graves. Caso essas lesões tenham persistido e/ou caso a criança tenha desenvolvido sintomas no período de acompanhamento, foi feita microlaringoscopia sob anestesia geral para avaliar a ES. Resultados: Incluímos 36 crianças. A incidência da ES foi de 11,1%. As crianças com ES apresentaram um maior percentual de escores da escala COMFORT-B entre 23 e 30 (subsedados) que os que não desenvolveram ES (15,8% em comparação a 3,65%, p = 0,004). Conclusão: As crianças que desenvolveram ES foram menos sedadas que as crianças que não desenvolveram ES. Keywords: Larynx, Airway stenosis/reconstruction, Children, Palavras-chave: Laringe, Estenose/Reconstrução das vias aéreas, Criançashttp://www.sciencedirect.com/science/article/pii/S0021755717300402 |
| spellingShingle | Cláudia Schweiger Denise Manica Denise Rotta Rutkay Pereira Paulo Roberto Antonacci Carvalho Jefferson Pedro Piva Gabriel Kuhl Leo Sekine Paulo José Cauduro Marostica Undersedation is a risk factor for the development of subglottic stenosis in intubated children Jornal de Pediatria |
| title | Undersedation is a risk factor for the development of subglottic stenosis in intubated children |
| title_full | Undersedation is a risk factor for the development of subglottic stenosis in intubated children |
| title_fullStr | Undersedation is a risk factor for the development of subglottic stenosis in intubated children |
| title_full_unstemmed | Undersedation is a risk factor for the development of subglottic stenosis in intubated children |
| title_short | Undersedation is a risk factor for the development of subglottic stenosis in intubated children |
| title_sort | undersedation is a risk factor for the development of subglottic stenosis in intubated children |
| url | http://www.sciencedirect.com/science/article/pii/S0021755717300402 |
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