Flexible bronchoscopic diagnosis of airway injuries after intubation in children

Background: Airway intubation injuries occur frequently but are often negle cted because of spontaneous regression. Although most airway injuries that result from intubation resolve without sequelae, severe complications can d evelop even when initial symptoms of upper airway obstruction are absent. T his retrospective study assessed the clinical features, flexible bronchosco pic findings, and clinical outcomes in children with airway intubation inju ries. Methods: From February 1998 to February 1999, 90 children underwent flexibl e bronchoscopic examination in our hospital. Fifteen of these patients (6 g irls, 9 boys; age range, 1 mo to 5 yr; mean, 21.1 +/- 24.1 mo) were noted t o have intubation injuries. Results: The average time for symptoms to emerge after extubation was 1.8 d ays (range, 0-14 days). The airway intubation injuries diagnosed by flexibl e bronchoscopy were subglottic stenosis in seven patients, vocal cord granu lation in four, supraglottic granulation in two, subglottic web in two, bro nchial granulation in two, glottic stenosis in one, and tracheal stenosis i n one; two cases were discovered incidentally during postoperative follow-u p. Four patients had undergone repeated intubation and eventually required tracheostomy. Conclusions: The results of this study indicate that flexible bronchoscopy is a simple, safe, and useful technique for the diagnosis and follow-up of airway intubation injury. It should be performed on all patients who have s ymptoms,ms of upper airway obstruction after extubation as well as those wh o have undergone long-term or emergency intubation.