title: Airway injury resulting from repeated endotracheal intubation: Possible prevention strategies.
abstract: 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.
authors.affiliation: Nemours Research Lung Center, Alfred I. duPont Hospital for Children, Wilmington, DE, USA. aoshodi@cmh.edu
authors.forename: Adebayo
authors.initials: A
authors.lastname: Oshodi
authors.forename: Kevin
authors.initials: K
authors.lastname: Dysart
authors.forename: Alison
authors.initials: A
authors.lastname: Cook
authors.forename: Elena
authors.initials: E
authors.lastname: Rodriguez
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhu
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Shaffer
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Miller
mesh_terms: 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
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D019819:Budesonide; D003907:Dexamethasone