Influence of laryngeal and general diseases on postintubation changes of the larynx

© Borgis - New Medicine 4/2010, s. 115-117

*Lidia Zawadzka-Głos¹, Mansoor Sharifi^1,2, Mieczysław Chmielik¹

Summary
Introduction. There are numerous indications for tracheotomy in children. At present the dominating indications are laryngeal postintubation complications. In recent years laryngeal postintubation complications in children have been noticeable.
Aim. The aim of the study was to analyze additional diseases and local conditions of the larynx preceding intubation in children in whom tracheotomy was performed due to postintubation complications.
Material and method. A group of 124 children with tracheotomy treated in our clinic in the period of 1990-2009 was available for our study. The main indication for tracheotomy in 92 (75%) of the children was postintubation complications. In this group of 92 patients with postintubation complication we have evaluated the presence of accompanying additional general diseases and local condition of the larynx, which could have affected the development of postintubation complications.
Results. In the group of 92 children with postintubation complications, 62 children (67.39%) had a healthy larynx and in the other 30 children (32.61%) other additional diseases or laryngeal malformations were observed. In that group of children with laryngeal malformations, 22 children had laryngomalacia (73.33%), and 8 (26.67%) had paralysis of the vocal cords with etiology other than postintubation. Only 11 children (11.96%) had no additional general diseases and in the other 81 patients (88.04%) other serious general diseases were diagnosed. Among the accompanying diseases were: heart and cardiovascular diseases requiring cardiosurgical operations in 17 children (18.48%), diseases of the nervous system in 17 patients (18.84%), diseases of the respiratory system in 15 patients (16.3%), multisystem congenital malformations in 23 patients (25%), and hypoxia of the CNS at birth in 9 patients (9.78%). In the group of 92 patients with laryngeal postintubation complications clinical symptoms such as laryngeal stridor were observed in 37 patients (40.22%) in the period of 1-21 days after extubation. On the other hand, in 55 patients (59.78%), extubation was not possible for longer than 1 day due to increasing stridor and respiratory failure of the patient.
Conclusions. At present the most common reasons for tracheotomy in children are laryngeal postintubation complications. Children with changes in the vicinity of the larynx, and especially those with laryngomalacia, are more at risk of developing postintubation complications. Severe general diseases related to hypoxia increase the risk of laryngeal postintubation complications. Patients with history of cardiosurgical operations are at greater risk of developing laryngeal postintubation complications.

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