Prevalence of laryngotracheal injury in chronically tracheostomized children at a large referral center.

Objective: To assess the prevalence and factors associated with laryngotracheal lesions in chronically tracheostomized children followed at a comprehensive care center for tracheostomized patients.

Study Design: Cross-sectional study.

Setting: Tertiary care hospital.

Methods: Between 2011 and 2018, tracheostomized children were submitted to flexible bronchoscopy and divided into groups according to the findings: laryngotracheal injury without subglottic stenosis; laryngotracheal injury with subglottic stenosis; and normal airway. Multivariate analysis was performed with the covariates main indication for tracheostomy, age, duration of intubation, sex, and comorbidities.

Results: A total of 195 children were included, the median age at tracheostomy was 12 months, and upper airway obstruction was the indication for tracheostomy in 63.1%. Of the 195 patients evaluated, 41 (21%) had laryngotracheal injury without subglottic stenosis, 132 (67.7%) had laryngotracheal injury with subglottic stenosis, and 22 (11.3%) had a normal airway. In the final multivariate analysis, being intubated for ≥21 days increased the overall risk of subglottic stenosis (OR = 6.98; 95% CI, 1.42-34.3), which was significantly more common among the patients with laryngotracheal injury and subglottic stenosis than among those with laryngotracheal injury only and those with a normal airway (OR = 5.82; 95% CI, 1.44-23.52).

Conclusions: In our sample, the most prevalent lesion was subglottic stenosis The duration of intubation appears to be associated with the occurrence of laryngotracheal injury in tracheostomized children.