Therapeutic reintubation for post-intubation laryngotracheal injury in preterm infants

The failure to extubate a preterm infant after prolonged intubation is often caused by laryngotracheal injury. This condition is treated by tracheotomy, anterior cricoid split, or often, by reintubation and subsequent extubation attempts in a later stage. To assess the value of reintubation as treatment of post-intubation injury, we retrospectively studied a group of preterm infants from the neonatal intensive care unit in the Sophia Children's Hospital. Three categories of injury were distinguished according to the findings at laryngobronchoscopy: (a) edema or superficial lesions, (b) ulcerations and edema and (c) granulations. Twenty-three infants were therapeutically reintubated after post-intubation injury was diagnosed, for a mean period of 17 days. The therapy was successful in 22 patients, and a failure in one. The follow-up period was a mean 34 months. The result and the duration of the treatment vary with the category of the injury and the condition of the patient. Therapeutic reintubation is compared with alternatives such as anterior cricoid split and tracheotomy. We conclude that reintubation is a valuable therapy that should precede the decision for surgery.