Abstract
Potential hazards of intubation to larnygeal function have not been emphasized in the newborn and the cause of difficulties encountered at extubation are not clear. We examined at autopsy the trachea of 13 infants with respiratory distress, aged 14 to 98 days, who had been intubated for 9 to 44 days. Extensive diffuse necrosis of the mucosa, at times of cartilage rings, was seen in 4, multifocal squamous metaplasia in 2 and diffuse metaplasia in 6. These changes, related to decubital ulceration by a tightly fitted tube, and chronic irritation, explain the inability of the trachea to remove bronchial secretion after extubation. The spectrum of early and late changes was followed in 25 larynxes. Besides known alterations such as ulcers, metaplasia and granulomas, there were deep lesions attributed to compression of vessels between the tube and the cartilages. Most striking was the necrosis and atrophy of intrinsic laryngeal muscles, even with a relatively preserved mucosa. This might well lead to permanent laryngeal dysfunction. (SPR)
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Symchych, P., Cadotte, M., Fojaco, R. et al. 87 Squamous Metaplasia and Necrosis of Trachea and Larynx after Nasotracheal Intubation of Premature Infants. Pediatr Res 1, 222 (1967). https://doi.org/10.1203/00006450-196705000-00094
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DOI: https://doi.org/10.1203/00006450-196705000-00094