SUBGLOTTIC STENOSIS (SGS) PASCA TRAUMA INHALASI
Managing Subglottic Stenosis (SGS) After Inhalation Trauma: Insights and Best Practices
Subglottic Stenosis (SGS) is a significant complication following inhalation trauma, occurring in a substantial number of patients post-intubation. This condition results from scar tissue formation and narrowing of the subglottic airway, often exacerbated by factors related to intubation. Research indicates that Laryngotracheal Stenosis (LTS), which includes SGS, affects 24-53% of patients after inhalation trauma, with complications and mortality rates varying.
A patient presented with extensive facial and extremity burns following an explosion in a confined space. Nine hours post-trauma, the patient experienced breathing difficulties and underwent intubation with a 6.5 mm cuffed Endotracheal Tube (ETT). Unfortunately, the cuff pressure was not monitored. After 38 days, the patient reported hoarseness and occasional breathing difficulties. Fiber Optic Laryngoscopy (FOL) revealed 30% subglottic narrowing, and the patient was diagnosed with Stage 1 SGS, which did not require surgical intervention and was managed with observation.
Results:
- Early Evaluation Importance: Early FOL evaluation is crucial after inhalation trauma to detect SGS early.
- Impact of Intubation Practices: SGS risk is increased by factors such as prolonged intubation, high cuff pressures, and multiple intubations. Recommended cuff pressure is 20-30 cmH2O, and it should be regularly monitored and adjusted.
- Risk Factors: The severity of inhalation injury, inflammation level, and ETT size play critical roles in the development of SGS.
The case highlights the importance of proper intubation techniques to prevent SGS. Early and frequent evaluation using FOL is essential for timely detection and management. Adhering to recommended cuff pressure ranges and using appropriately sized ETTs can help mitigate risks. Proper monitoring of cuff pressures and avoiding unnecessary intubations are key strategies in preventing serious subglottic complications.
Preventing Subglottic Stenosis after inhalation trauma involves careful intubation practices, including using small-sized ETTs and maintaining appropriate cuff pressures. Early evaluation with FOL and adherence to best practices in intubation can significantly reduce the risk of developing SGS and improve patient outcomes.
Explore more about effective management strategies for SGS and enhance your knowledge on best practices for intubation and airway management.
Learn More: https://doi.org/10.20473/jre.v6i2.31836 More Articles: https://e-journal.unair.ac.id/JRE/