title: Post-intubation subglottic stenosis in children. Diagnosis, treatment and prevention of moderate and severe stenosis.
abstract: OBJECTIVE
  Subglottic stenosis is one of the most common causes of upper airway obstruction. Almost 90% of them result from endotracheal intubation. Therapy depends on the degree of stenosis, among other factors. Therapeutic approaches range from watchful waiting, in mild stenosis, to complex surgery for severe cases. We report our experience on the surgical management of post-intubation subglottic stenosis in children, emphasising the need for recognition and prevention of predisposing factors of post-intubation stenosis.
  
  
  METHODS
  We retrospectively evaluated 71 patients with moderate to severe post-intubation subglottic stenosis, operated in the Respiratory Endoscopy Service in a period of eight years. The clinical variables analysed were age at surgery, degree of stenosis, surgical technique, complications and outcome.
  
  
  RESULTS
  In 84.5% of patients, only 1 surgical approach was required to achieve decannulation. Three surgical techniques were implemented as therapy: laryngotracheal reconstruction, partial cricotracheal resection and anterior cricoid split. Decannulation was achieved in 70 cases. In 71.8%, ventilation, swallowing and voice qualities were good; 23.9% presented dysphonia; and 2.8% presented a mild respiratory distress. One patient died.
  
  
  CONCLUSIONS
  In patients with subglottic stenosis, selection of the most accurate treatment is the key to success, reducing the number of surgeries and preventing complications.
authors.affiliation: Servicio de Endoscopia Respiratoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Hugo
authors.initials: H
authors.lastname: Rodríguez
authors.forename: Giselle
authors.initials: G
authors.lastname: Cuestas
authors.forename: Hugo
authors.initials: H
authors.lastname: Botto
authors.forename: Alejandro
authors.initials: A
authors.lastname: Cocciaglia
authors.forename: Mary
authors.initials: M
authors.lastname: Nieto
authors.forename: Adrián
authors.initials: A
authors.lastname: Zanetta
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007440:Intubation / Q000009:adverse effects; D007829:Laryngostenosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Children; Estenosis subglótica; Intubación; Intubation; Niños; Prevención; Prevention; Subglottic stenosis; Surgical treatment; Tratamiento quirúrgico