Estenosis subglótica adquirida: Tres años de experiencia (1999-2001)

Abstract

This is a retrospective analysis (Jan-99 to Dec-01) of 10 children with post extubation acquired subglottic stenosis (ASS) that counted for a 3% of all fiberoptic bronchoscopies performed during that period. Seven patients were male. Their age ranged from 26 weeks to 14 years old (8 of them were under one year old); 3 were prematures and one had a severe bronchopulmonary displasia. Intermittent Positive Pressure Ventilation (IPPV) was used in a period which ranged from 4 to 35 days, and in 7 cases it was longer than 7 days. ASS clinical presentation was stridor in 8 cases and it was an endoscopical finding in two pre-term infants. Six patients had over 70% reduction of the subglottic area (ASS III), 3 of them had a quick evolution to a pinpoint stenosis. Tracheostomy was performed in four patients (3 with ASS III and one with ASS II plus obstructive subglottic granuloma). Four infants under one year old (3 with ASS III and one with ASS II) were dilatated with an endotracheal tube and received topical Mitomycin-C. Three out of five patients treated with dilatation had an asymptomatic evolution. Two had a persistent mild stridor, one of them with a 50% subglottic area reduction after a 4 months follow-up. Three patients died: two of them had a tracheostomy and the other one an IPPV related pneumonia. Conclusion: ASS is a low prevalence pathology, it is associated with intubation longer than 7 days, it is more frequent in infants under one year old and in those with additional morbidity. Dilatations plus topic Mitomycin-C was a successful treatment in recent ASS II and III