From the Guidelines
Yes, sunglottic stenosis can cause low tidal volumes. Sunglottic stenosis is a condition where the airway is narrowed at the level of the glottis, which can restrict airflow to and from the lungs. This narrowing creates increased airway resistance, making it physically difficult for adequate volumes of air to pass through during breathing. As the stenosis worsens, patients typically experience progressively decreasing tidal volumes, which are the amount of air moved into or out of the lungs during normal breathing. According to a study published in the American Journal of Respiratory and Critical Care Medicine 1, acquired subglottic stenosis has been reported in 1.7 to 8% of previously intubated neonates, and clinical manifestations include postextubation stridor, hoarseness, apnea, and bradycardia, which can all contribute to low tidal volumes. The reduced airway diameter requires greater respiratory effort to maintain adequate ventilation, often leading to shallow, rapid breathing patterns with diminished tidal volumes.
Some key points to consider in the context of sunglottic stenosis and low tidal volumes include:
- The relationship between acute laryngeal or subglottic damage and development of acquired subglottic stenosis is unclear, but clinical manifestations such as postextubation stridor and hoarseness can indicate the presence of moderate to severe subglottic stenosis 1.
- Risk factors for laryngeal injury, such as intubation for 7 days or more, and three or more intubations, are also associated with acquired subglottic stenosis 1.
- Efforts to reduce the length of tracheal intubation or avoid intubation altogether have been associated with prevention of subglottic stenosis, and the use of nasal continuous positive airway pressure (CPAP) has been shown to decrease the incidence of subglottic stenosis 1.
- The use of inappropriately large endotracheal tubes has also been shown to be an important risk factor for the development of subglottic stenosis, and selection of appropriate-sized endotracheal tubes has been shown to decrease the incidence of subglottic stenosis 1.
Overall, sunglottic stenosis can cause low tidal volumes due to increased airway resistance and decreased airway diameter, and patients with significant subglottic stenosis may require interventions such as endoscopic dilation, laser treatment, or surgical reconstruction to restore adequate airway patency and improve tidal volumes.
From the Research
Presence of Sunglottic Stenosis and Tidal Volumes
- The presence of sunglottic stenosis, also known as subglottic stenosis, can indeed affect respiratory function, including tidal volumes 2, 3.
- Subglottic stenosis refers to the narrowing of the airway diameter below the vocal folds, which can be congenital or acquired, and may lead to symptoms such as recurrent croup, exertional stridor, and complete airflow obstruction requiring tracheotomy 2.
- The narrowing of the airway can restrict airflow, potentially resulting in low tidal volumes, as the lungs may not be able to expand fully due to the obstruction 3.
- Studies have shown that subglottic stenosis can cause significant morbidity and mortality, particularly in premature and medically fragile infants, and that the primary objective of intervention is decannulation or preventing the need for tracheotomy 3, 4.
- While the exact relationship between sunglottic stenosis and tidal volumes is not explicitly stated in the provided studies, it can be inferred that the presence of subglottic stenosis can lead to respiratory complications, including low tidal volumes, due to the narrowing of the airway 2, 3, 4.
Management and Treatment
- Management of subglottic stenosis often requires intricate surgical techniques, and a thorough assessment of the patient's airway, lungs, reflux, and swallow needs to be evaluated to optimize the success of these surgeries 2.
- Endoscopic and open surgical techniques continue to be investigated in a growing number of prospective clinical trials to determine optimal treatment protocols 4.
- In-office injections are also gaining popularity and show promise in the treatment of subglottic stenosis 4.