ABSTRACT
Abstract 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 cinco anos 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 oito horas da extubação e repetida 7-10 dias depois, caso o primeiro exame tivesse mostrado lesões laríngeas moderadas a graves. Caso essas lesões tivessem persistido e/ou caso a criança tivesse 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 com 3,65%, p = 0,004). Conclusão: As crianças que desenvolveram ES foram menos sedadas do que as que não desenvolveram.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Laryngostenosis/etiology , Intubation, Intratracheal/adverse effects , Severity of Illness Index , Laryngostenosis/diagnosis , Prospective Studies , Risk Factors , Deep Sedation , Airway ExtubationABSTRACT
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.