Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background Endotracheal intubation plays a vital role in pediatric critical care. Yet, post-extubation laryngeal injuries have many adverse effects on patients{u201F} outcome. It is important to identify and grade them and risk factors related. Aim: Identification of the frequency, types and severity of post-extubation injuries and associated risk factors. Methodology: Fourty children aging from 3 month to ten years were included, all the children were ventilated more than 48 hours, cases were recruited from the pediatric intensive care units of Cairo university pediatric Hospitals. Flexible laryngoscopy was done to all patients within 24 hours of extubation. Patients were followed for their course of ventilation, extubation success or failure and ICU complications and survival. Results: We found high incidence of moderate to severe injuries in our patients (50%). This group of patietns were less like to be ventilated for acute respiratory diseases (p: 0.006), they had more frequent complications, for pneumothorax (p: 0.018), VAP (p: 0.000). These patients had longer time to 1st extubation (p: 0.000), more intubation attempts (p: 0.000), and more junior attending physicians (p: 0.026). Higher rates of extubation failure were among severe group (p: 0.001). Overall mortality was 30%, with majority of it in the severe group. Conclusion: Post extubation laryngeal injuries are common and are associated with longer time to 1st extubation, junior performing physicians and increased number of attempts, these injuries were related to unfavorable outcome of patients

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