Pediatric Otolaryngologist Prematurely Removes Ventilator Support

Case Overview

This case involves a six-month-old infant who was diagnosed with group B strep meningitis. Due to respiratory distress, the patient required intubation and a tracheotomy. For several months, the patient received constant nursing home care while a ventilator assisted his breathing. The patient underwent a direct laryngoscopy, bronchoscopy, and balloon dilation to correct subglottic stenosis. Immediately after surgery, the patient was quickly weaned off of the ventilator after depending on the machine for an extended period of time. The patient was discharged the same day as the surgery to a pediatric long-term care facility. Upon arrival, his mother noticed that he was having significant trouble breathing. The child was rushed back to the emergency room and was intubated. The patient died three days later due to cardiac and respiratory arrest.

Questions to the ENT expert and their responses

Is there any way to prevent subglottic stenosis from developing?

Acquired subglottic stenosis (SGS) is often caused by endotracheal intubation. Mechanical trauma from an endotracheal tube, as it passes through or remains for long periods in the narrowed neonatal airway, can lead to mucosal edema and hyperemia. These conditions then can progress to pressure necrosis of the mucosa. These changes have been reported in the literature to occur within a few hours of intubation and may progress to expose the perichondrium of the cricoid cartilage. Infection of the perichondrium can result in a subglottic scar, which can be hastened if an oversized endotracheal tube is used. It is important to always check for an air leak after placing an endotracheal tube because of the risk of necrosis of the mucosa, which can occur even in short surgical procedures.

About the expert

This expert has been practicing for over 25 years. He is actively involved in numerous professional societies relevant to his field, and has previously served as Board Member and President of the American Society of Pediatric Otolaryngology. He currently maintains active affiliations and privileges at 10 area hospitals. He is also on the editorial board and is an ad hoc reviewer of various medical journals and has won numerous honors and awards, and has been given grants for research in his field. Finally, he has been published over 200 times and has been invited to lecture at conferences and symposia.

E-000660

Specialties:

ENT

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