Airway injury resulting from repeated endotracheal intubation: Possible prevention strategies.
OBJECTIVE
To characterize physical and inflammatory injury that may result from repeated intubation, independent of positive-pressure ventilation; and to determine whether corticosteroids can attenuate injury and or inflammation that may result from repeated intubation.


METHODS
A 4-hr animal protocol.


METHODS
All work was done in the animal laboratory at the Alfred I. DuPont Hospital for Children.


METHODS
Neonatal piglets (2-8 days old; 2.5 ± 0.4 kg) were intubated and randomized to four groups (n = 8 each) to be followed over 4 hrs. Groups were control (not reintubated), injured (reintubated every 0.5 hr), intratracheal pretreatment with 1 mg of nebulized budesonide (intratracheal pretreated), or intravenous pretreatment with 0.3 mg/kg of dexamethasone (intravenous pretreated).


METHODS
Each pig was sedated for the duration of study and had a 3.5F catheter inserted in the femoral artery for blood sampling and blood pressure measurement every hour. After 4 hrs, each pig was killed, and tissue was harvested for histology and interleukin-6 assays.


RESULTS
Laryngeal tissue interleukin-6 content was greater in the injured group compared with the control group (p < .05). In the intratracheal pretreated group, the interleukin-6 content of laryngeal tissue was greater compared with the control group (p < .05), whereas the intravenous pretreated group was not different from the control group. The reintubation injury resulted in plasma interleukin-6 levels that, compared with control, were greater in the injured and intratracheal pretreated groups (p < .05). Quantitative histology showed that the degree of tracheal injury was higher in injured and intratracheal pretreated groups compared with the control group (p < .05).


CONCLUSIONS
Repeated intubation alone results in significant tracheal trauma and systemic inflammation. Intravenous but not inhaled steroids attenuated the injury.
Oshodi
Adebayo
A
Nemours Research Lung Center, Alfred I. duPont Hospital for Children, Wilmington, DE, USA. aoshodi@cmh.edu
Dysart
Kevin
K
Cook
Alison
A
Rodriguez
Elena
E
Zhu
Yan
Y
Shaffer
Thomas H
TH
Miller
Thomas L
TL
D000402:Airway Obstruction / Q000209:etiology* / Q000517:prevention & control*; D000704:Analysis of Variance; D000818:Animals; D000831:Animals, Newborn; D015415:Biomarkers / Q000097:blood; D019819:Budesonide / Q000494:pharmacology*; D003907:Dexamethasone / Q000494:pharmacology*; D004195:Disease Models, Animal; D007249:Inflammation / Q000517:prevention & control; D015601:Injury Severity Score; D015850:Interleukin-6 / Q000097:blood; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007830:Larynx / Q000293:injuries*; D011897:Random Allocation; D013552:Swine
D015415:Biomarkers; D015850:Interleukin-6; D019819:Budesonide; D003907:Dexamethasone