Intubation Injuries of the Trachea in Children: Management and Prevention

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Internal tracheal injury in children is increasing at an alarming rate, and although critically ill patients are being salvaged by prolonged respiratory support, many subsequently develop tracheal stenosis. From our experience with 40 children with chronic and subacute tracheal stenosis, we have developed a technique of management for the child with an acute intubation injury to the trachea. Whenever an endotracheal tube has been attached to a respirator or has been in place for over 72 hours, roentgenographic studies of the airway are obtained soon after removal. If there is evidence of a constricted lumen, bronchoscopy is performed and granulation tissue is removed. Triamcinolone is injected endoscopically into the area of injury, and a polyvinyl soft endotracheal tube is passed through the nose and into the trachea beyond the site of injury. This tube serves as a stunt and systemic steroids (dexamethasone), 0.8 mg/kg/day, and broad-spectrum antibiotics are administered for 72 hours. The child is sedated with the head restrained. The stunt is removed after 72 hours, and racemic epinephrine is administered along with other measures to prevent edema. Prednisone is then given orally for 4–6 weeks. This method has been successfully used in 15 children with acute tracheal intubation injuries.

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