Prolonged Oro-Naso-Tracheal Intubation in Children

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Abstract
The maximal period allowed for oro-or nasotracheal intubation without much risk for laryngeal damage has previously been recognised as 24 hours. This conclusion was based on investigations that do not seem to have properly evaluated such factors as laryngeal activity during the period of intubation, material and size of tube, general condition and fluid balance of the patient and finally measures to prevent undue movements of the tube. In 1962 Brandstater reported the use of oro- or nasotracheal intubation in infants over periods far in excess of 24 hours and without a high incidence of laryngeal damage. Many groups have later used this methods as an alternative to tracheostomy in children. Although different technical recommendations have been given they all have in common: suppression of laryngeal motor activity and avoidance of a tube-diameter that does not easily fit the larynx and trachea. Humidification must be optimal in order to avoid sticky secretions and blocking of the tube. This method of prolonged laryngeal intubation as an alternative to tracheostomy has been used by us during the last two years. An account of our technique, experience and complications will be given.