title: Association between length of intubation and subglottic stenosis in children.
abstract: OBJECTIVE
  To investigate the role of the length of intubation and other risk factors in the development of laryngeal lesions in children undergoing endotracheal intubation in an intensive care unit and to determine the incidence of subglottic stenosis (SGS).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Children aged from birth to <5 years admitted to the Pediatric Intensive Care Unit of Hospital de Clinicas de Porto Alegre who required endotracheal intubation for more than 24 hours were eligible. Children underwent flexible fiber-optic laryngoscopy (FFL) after extubation. Those who presented moderate to severe abnormalities in this first examination underwent another FFL between 7 and 10 days. If lesions persisted or symptoms developed, regardless of initial findings, laryngoscopy under general anesthesia was performed.
  
  
  RESULTS
  We followed 142 children. In the first FFL, 58 children (40.8%) had moderate to severe laryngeal lesions. During follow-up, 16 children developed SGS, representing an incidence of 11.3% (95% confidence interval, 7.1-17.5). Multivariate analysis showed that for every 5 additional days of intubation, there was a 50.3% increase in the risk of developing SGS, and for each additional sedation doses/day, there was a 12% increase in the same outcome.
  
  
  CONCLUSIONS
  In this first prospective research protocol in children, we found a higher incidence of SGS than in most previous studies. The length of intubation and the need for additional sedation doses appear to be key factors for the development of SGS during endotracheal intubation.
authors: Otolaryngology Department, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil. denisemanica@gmail.com.
authors: Denise
authors: D
authors: Manica
authors: Cláudia
authors: C
authors: Schweiger
authors: Paulo José Cauduro
authors: PJ
authors: Maróstica
authors: Gabriel
authors: G
authors: Kuhl
authors: Paulo Roberto Antonacci
authors: PR
authors: Carvalho
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007828:Laryngoscopy; D007829:Laryngostenosis / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives