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Papers of the Week

2023 Jan 31

Paediatr Anaesth

The Role of Local Inflammation in Complications Associated with Intubation in Pediatric Patients: A Narrative Review.


Amaya S, Murillo M, Gutiérrez ML, Cervera HS, Andrade MJ, Zuñiga MA, Barreto N, Daza MI, Carvajal L, Alarcón CM, Aponte L, Olbrecht VA
Paediatr Anaesth. 2023 Jan 31.
PMID: 36719267.


Although the most important primary local inflammatory response factor to intubation is not yet clear, it is known that it may be directly attributed to the presence of trauma during intubation or the response of oral bacterial flora present in the trachea. It is known that prolonged intubation is associated with worse outcomes, but other underlying systemic issues, such as sepsis and trauma, are also associated with this result. Likewise, patients who require advanced airway management and excessive manipulation are more likely to experience complications. There are various inflammatory mediators that are generated during orotracheal intubation, many of which can be considered targets for therapies to help reduce inflammation caused by intubation. However, there is little evidence on the management of the inflammatory response induced by orotracheal intubation in pediatric patients. Therefore, the aim of this narrative review is to highlight the intubation associated complications that can arise from poorly controlled inflammation in intubated pediatric patients, review the proposed pathophysiology behind this, and discuss the current treatments that exist. Finally, taking into account the discussion on pathophysiology, we describe the current therapies being developed and future directions that can be taken in order to create more treatment options within this patient population.