title: "Post intubation Laryngeal injuries in a pediatric intensive care unit of tertiary hospital in India: A Fibreoptic endoscopic study".
abstract: OBJECTIVE
  To identify acute laryngeal injuries among pediatric patients intubated for more than 48hours, and to correlate these injuries with clinical variables.
  
  
  METHODS
  Pediatric Intensive Care Unit (PICU) of a tertiary level hospital in India.
  
  
  METHODS
  Prospective, observational study. Thirty-four children meeting the inclusion and exclusion criteria were recruited into the study after obtaining informed consent from the parents. A bedside, flexible, fiberoptic laryngoscopy was done within the first 24hours of extubation. Laryngeal injuries were documented and graded. Individual types of laryngeal injuries were correlated to the duration of intubation, size of the tube, the experience of the intubator and the patient's demographics. A repeat endoscopy was done in the outpatient department, 3-4 weeks after extubation, and findings noted.
  
  
  RESULTS
  97% had acute laryngeal injury, of which 88% were significant. Erythema was the most common form of injury. Duration of intubation, with a mean of 4.5 days, showed a trend towards significance (p=0.06) for association with subglottic narrowing. Laryngeal injuries were similar with both cuffed and uncuffed tubes. Age of the subject, size of the tube and skill level of the intubator did not correlate with the laryngeal injuries. 18% required intervention for post-extubation laryngeal lesions. Three (10%) children had post-extubation stridor, and of these, two needed surgical intervention (6%).
  
  
  CONCLUSIONS
  Post-extubation laryngeal injuries are not uncommon. Fiberoptic endoscopy is an inexpensive and cost-effective tool for bedside evaluation of post-intubation status in pediatric larynx. Early diagnosis of post-intubation laryngeal injuries in children can prevent long term sequelae. Hence, post-extubation fiberoptic laryngoscopy should be done routinely in pediatric population.
authors.affiliation: Former Registrar, Department of ENT, Christian Medical College, Vellore, India (Presently Assistant Professor, Department of ENT, Himalayan Institute of Medical Sciences, Dehradun, India.
authors.forename: Bhartendu
authors.initials: B
authors.lastname: Bharti
authors.affiliation: Assistant Professor, Department of ENT, Christian Medical College, Vellore, India. Electronic address: skamrann@gmail.com.
authors.forename: Kamran Asif
authors.initials: KA
authors.lastname: Syed
authors.affiliation: Professor, Pediatric Intensive Care, Christian Medical College, India.
authors.forename: Kala
authors.initials: K
authors.lastname: Ebenezer
authors.affiliation: Professor Department of ENT, Christian Medical College, Vellore, India.
authors.forename: Ajoy Mathew
authors.initials: AM
authors.lastname: Varghese
authors.affiliation: Former Professor, Department of ENT, Christian Medical College, Vellore, India.
authors.forename: Mary
authors.initials: M
authors.lastname: Kurien
mesh_terms: D000293:Adolescent; D060666:Airway Extubation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005336:Fiber Optic Technology; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation; D007830:Larynx / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D011446:Prospective Studies; D062606:Tertiary Care Centers
keywords: Fiberoptic laryngoscopy; Post-intubation laryngeal injuries