What factors lead to poor outcomes for children with acute post-intubation laryngeal injuries?
Reviewed by Gemma Clunie

Endotracheal intubation is well known to carry a risk of acute laryngeal injury. These problems range in severity and can lead to chronic problems but, when laryngeal injuries are identified and treated early, there are fewer complications. The authors of this study describe their management of acute post-extubation laryngeal injuries in a paediatric caseload to determine the outcomes of their preferred treatment methods (balloon laryngoplasty (BLP) and/or reintubation with a smaller tube wrapped in corticosteroid and antibiotics ointment) and what factors lead to a worse outcome. Their case series included 59 patients (age range 2–18; 53% female). The patients were split into a ‘success’ group (n=50) and a ‘failure’ group (n=9) defined as need for tracheostomy after treatment. Three of the ‘failure’ group were successfully decannulated without open surgery, four required open surgery and two could not be decannulated. Multivariate analysis of the cohort identified predictive treatment factors for poor prognosis as: number of reintubations with antibiotics and corticosteroid ointment, symptoms returning rapidly between endoscopic interventions, and number of total airway endoscopies as well as number of endoscopies with interventions. Lesion types associated with poor prognosis were severe glottic or subglottic oedema and posterior glottic stenosis. The authors describe that 84% of their patients were managed successfully with their preferred endoscopic treatment approaches, but that further research is required to determine their efficacy compared to other endoscopic treatments. They acknowledge that factors associated with poor prognosis also need further investigation.

Post-Intubation Acute Laryngeal Injuries: Analysis of Predictive Factors of Poor Prognosis.
Lira NE, Kujl LP, Maróstica C, et al.
LARYNGOSCOPE 
2025;135(10):3453–69.