Possible risk factors associated with moderate or severe airway injuries in children who underwent endotracheal intubation

OBJECTIVE: To analyze the role of risk factors associated with moderate or severe airway injuries in children who underwent endotracheal intubation. DESIGN: Prospective cohort study. SETTING: Pediatric intensive care unit. PATIENTS: All patients who required endotracheal intubation during a 25-mo period (October 1999 through October 2001). Exclusion criteria were death before extubation and weight of <1250 g. INTERVENTIONS: Airway endoscopy at extubation and reevaluation for those reintubated. MEASUREMENTS: Relative risks and 95% confidence intervals were calculated in the univariate risk factor analysis (age, sex, organ failure, difficult intubation, tube size, reintubation, tube changes, and duration of intubation). p Values were calculated from the chi-square test with Yates' correction or for trend, and a value of <.05 was considered significant. To define which of the main variables were independently associated with the outcomes of interest, we used logistic stepwise forward modeling. The Mantel-Haenszel method was used for the stratified analysis between the two independently associated variables. RESULTS: The study population consisted of 215 patients (61 newborns and 154 children). Moderate lesions occurred in 24.2% of patients, and severe lesions in 10.7% of patients. Risk factors associated with moderate or severe injury in a univariate analysis were age, sex, organ failure, reintubation, tube changes, and longer duration of intubation. According to Mantel-Haenszel stratified analysis results, reintubation and tube changes were the only variables independently associated with the outcomes. CONCLUSIONS: We concluded that to prevent morbidity secondary to airway injury, efforts should be directed to avoid reintubation and tube changes in the concerned scenario.