title: Corrosion casting of the subglottis following endotracheal tube intubation injury: a pilot study in Yorkshire piglets.
abstract: OBJECTIVE
  Subglottic stenosis can result from endotracheal tube injury. The mechanism by which this occurs, however, is not well understood. The purpose of this study was to examine the role of angiogenesis, hypoxia and ischemia in subglottic mucosal injury following endotracheal intubation.
  
  
  METHODS
  Six Yorkshire piglets were randomized to either a control group (N=3, ventilated through laryngeal mask airway for corrosion casting) or accelerated subglottic injury group through intubation and induced hypoxia as per a previously described model (N=3). The vasculature of all animals was injected with liquid methyl methacrylate. After polymerization, the surrounding tissue was corroded with potassium hydroxide. The subglottic region was evaluated using scanning electron microscopy looking for angiogenic and hypoxic or degenerative features and groups were compared using Mann-Whitney tests and Friedman's 2-way ANOVA.
  
  
  RESULTS
  Animals in the accelerated subglottic injury group had less overall angiogenic features (P=.002) and more overall hypoxic/degenerative features (P=.000) compared with controls. Amongst angiogenic features, there was decreased budding (P=.000) and a trend toward decreased sprouting (P=.037) in the accelerated subglottic injury group with an increase in intussusception (P=.004), possibly representing early attempts at rapid revascularization. Amongst hypoxic/degenerative features, extravasation was the only feature that was significantly higher in the accelerated subglottic injury group (P=.000).
  
  
  CONCLUSIONS
  Subglottic injury due to intubation and hypoxia may lead to decreased angiogenesis and increased blood vessel damage resulting in extravasation of fluid and a decreased propensity toward wound healing in this animal model.
authors.forename: Lukas H
authors.initials: LH
authors.lastname: Kus
authors.forename: Michael C
authors.initials: MC
authors.lastname: Sklar
authors.forename: Jaina
authors.initials: J
authors.lastname: Negandhi
authors.forename: Marvin
authors.initials: M
authors.lastname: Estrada
authors.forename: Antoine
authors.initials: A
authors.lastname: Eskander
authors.forename: Robert V
authors.initials: RV
authors.lastname: Harrison
authors.forename: Paolo
authors.initials: P
authors.lastname: Campisi
authors.forename: Vito
authors.initials: V
authors.lastname: Forte
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Propst
mesh_terms: D000818:Animals; D016319:Corrosion Casting; D005931:Glottis / Q000473:pathology*; D000860:Hypoxia / Q000503:physiopathology*; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D018919:Neovascularization, Physiologic / Q000502:physiology*; D010865:Pilot Projects; D020545:Respiratory Mucosa / Q000473:pathology*; D013552:Swine; D014945:Wound Healing / Q000502:physiology