European Archives of Oto-Rhino-Laryngology ( IF 1.9 ) Pub Date : 2024-02-08 , DOI: 10.1007/s00405-024-08458-7 L L Veder 1 , K F M Joosten 2 , M K Timmerman 1 , B Pullens 1
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Purpose
The purpose of this study is to evaluate all potential factors associated with laryngeal injury after endotracheal intubation in the pediatric population.
Methods
A systematic literature search was conducted in Medline, Embase, Cochrane, web of science and Google scholar up to 20th of March 2023. We included all unique articles focusing on factors possibly associated with intubation-injury in pediatric patients. Two independent reviewers determined which articles were relevant by coming to a consensus, quality of evidence was rated using GRADE criteria. All articles were critically appraised according to the PRISMA guidelines. The articles were categorized in four outcome measures: post-extubation stridor, post-extubation upper airway obstruction (UAO) necessitating treatment, laryngeal injury found at laryngoscopy and a diagnosed laryngotracheal stenosis (LTS).
Results
A total of 24 articles with a total of 15.520 patients were included. The incidence of post-extubation stridor varied between 1.0 and 30.3%, of post-extubation UAO necessitating treatment between 1.2 and 39.6%, of laryngeal injury found at laryngoscopy between 34.9 to 97.0% and of a diagnosed LTS between 0 and 11.1%. Although the literature is limited and quality of evidence very low, the level of sedation and gastro-esophageal reflux are the only confirmed associated factors with post-extubation laryngeal injury. The relation with age, weight, gender, duration of intubation, multiple intubations, traumatic intubation, tube size, absence of air leak and infection remain unresolved. The remaining factors are not associated with intubation injury.
Conclusion
We clarify the role of the potential factors associated with laryngeal injury after endotracheal intubation in the pediatric population.
中文翻译：
儿童插管后喉部损伤的相关因素：系统评价
目的
本研究的目的是评估儿科人群气管插管后与喉部损伤相关的所有潜在因素。
方法
截至 2023 年 3 月 20 日，我们在 Medline、Embase、Cochrane、web of science 和 Google seller 上进行了系统的文献检索。我们收录了所有关注可能与儿科患者插管损伤相关因素的独特文章。两名独立审稿人通过达成共识来确定哪些文章相关，并使用 GRADE 标准对证据质量进行评级。所有文章均根据 PRISMA 指南进行严格评价。这些文章分为四种结果指标：拔管后喘鸣、拔管后需要治疗的上气道阻塞（UAO）、喉镜检查发现的喉损伤和诊断的喉气管狭窄（LTS）。
结果
共纳入 24 篇文章，共计 15.520 名患者。拔管后喘鸣的发生率在 1.0% 到 30.3% 之间，拔管后 UAO 需要治疗的发生率在 1.2% 到 39.6% 之间，喉镜检查发现喉部损伤的发生率在 34.9% 到 97.0% 之间，诊断 LTS 的发生率在 0% 到 11.1% 之间。尽管文献有限且证据质量很低，但镇静水平和胃食管反流是唯一证实的与拔管后喉损伤相关的因素。与年龄、体重、性别、插管持续时间、多次插管、插管创伤、插管尺寸、无漏气和感染的关系仍未解决。其余因素与插管损伤无关。
结论
我们阐明了儿科人群气管插管后喉损伤相关潜在因素的作用。
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