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Corrosion casting of the subglottis following endotracheal tube intubation injury: a pilot study in Yorkshire piglets.

Kus LH, Sklar MC, Negandhi J, Estrada M, Eskander A, Harrison RV, Campisi P, Forte V, Propst EJ - J Otolaryngol Head Neck Surg (2013)

Bottom Line: The subglottic region was evaluated using scanning electron microscopy looking for angiogenic and hypoxic or degenerative features and groups were compared using Mann-Whitney tests and Friedman's 2-way ANOVA.Amongst hypoxic/degenerative features, extravasation was the only feature that was significantly higher in the accelerated subglottic injury group (P=.000).Subglottic injury due to intubation and hypoxia may lead to decreased angiogenesis and increased blood vessel damage resulting in extravasation of fluid and a decreased propensity toward wound healing in this animal model.

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ABSTRACT

Purpose: Subglottic stenosis can result from endotracheal tube injury. The mechanism by which this occurs, however, is not well understood. The purpose of this study was to examine the role of angiogenesis, hypoxia and ischemia in subglottic mucosal injury following endotracheal intubation.

Methods: Six Yorkshire piglets were randomized to either a control group (N=3, ventilated through laryngeal mask airway for corrosion casting) or accelerated subglottic injury group through intubation and induced hypoxia as per a previously described model (N=3). The vasculature of all animals was injected with liquid methyl methacrylate. After polymerization, the surrounding tissue was corroded with potassium hydroxide. The subglottic region was evaluated using scanning electron microscopy looking for angiogenic and hypoxic or degenerative features and groups were compared using Mann-Whitney tests and Friedman's 2-way ANOVA.

Results: Animals in the accelerated subglottic injury group had less overall angiogenic features (P=.002) and more overall hypoxic/degenerative features (P=.000) compared with controls. Amongst angiogenic features, there was decreased budding (P=.000) and a trend toward decreased sprouting (P=.037) in the accelerated subglottic injury group with an increase in intussusception (P=.004), possibly representing early attempts at rapid revascularization. Amongst hypoxic/degenerative features, extravasation was the only feature that was significantly higher in the accelerated subglottic injury group (P=.000).

Conclusions: Subglottic injury due to intubation and hypoxia may lead to decreased angiogenesis and increased blood vessel damage resulting in extravasation of fluid and a decreased propensity toward wound healing in this animal model.

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Related in: MedlinePlus

Box plots comparing total aggregate vascular features. (A) Total angiogenesis includes vessel budding, sprouting, and intussusceptions. (B) Total hypoxic/degenerative features includes extravasations, corrugations, and circular constrictions. Median values are displayed as a line within a box, the borders of which denote the inter-quartile range. Asterisks indicate significance levels.
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Figure 6: Box plots comparing total aggregate vascular features. (A) Total angiogenesis includes vessel budding, sprouting, and intussusceptions. (B) Total hypoxic/degenerative features includes extravasations, corrugations, and circular constrictions. Median values are displayed as a line within a box, the borders of which denote the inter-quartile range. Asterisks indicate significance levels.

Mentions: Results are outlined in Table 1. Animals in the accelerated subglottic injury group had less overall angiogenic features (P=.002) and more overall hypoxic/degenerative features (P=.000) compared with controls (Figure 6). Amongst angiogenic features, there was decreased budding (P=.000) and a trend toward decreased sprouting (P=.037) in the accelerated subglottic injury group with an increase in intussusception (P=.004). Amongst hypoxic/degenerative features, extravasation was the only feature that was significantly higher in the accelerated subglottic injury group (P=.000). The total degree of sprouting-type angiogenesis (budding and sprouting) was higher than intussusceptive angiogenesis in both controls and accelerated subglottic injury animals. The overall intra-class correlation coefficient for the two observers counting vessels was .999, indicating very high reliability.


Corrosion casting of the subglottis following endotracheal tube intubation injury: a pilot study in Yorkshire piglets.

Kus LH, Sklar MC, Negandhi J, Estrada M, Eskander A, Harrison RV, Campisi P, Forte V, Propst EJ - J Otolaryngol Head Neck Surg (2013)

Box plots comparing total aggregate vascular features. (A) Total angiogenesis includes vessel budding, sprouting, and intussusceptions. (B) Total hypoxic/degenerative features includes extravasations, corrugations, and circular constrictions. Median values are displayed as a line within a box, the borders of which denote the inter-quartile range. Asterisks indicate significance levels.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815236&req=5

Figure 6: Box plots comparing total aggregate vascular features. (A) Total angiogenesis includes vessel budding, sprouting, and intussusceptions. (B) Total hypoxic/degenerative features includes extravasations, corrugations, and circular constrictions. Median values are displayed as a line within a box, the borders of which denote the inter-quartile range. Asterisks indicate significance levels.
Mentions: Results are outlined in Table 1. Animals in the accelerated subglottic injury group had less overall angiogenic features (P=.002) and more overall hypoxic/degenerative features (P=.000) compared with controls (Figure 6). Amongst angiogenic features, there was decreased budding (P=.000) and a trend toward decreased sprouting (P=.037) in the accelerated subglottic injury group with an increase in intussusception (P=.004). Amongst hypoxic/degenerative features, extravasation was the only feature that was significantly higher in the accelerated subglottic injury group (P=.000). The total degree of sprouting-type angiogenesis (budding and sprouting) was higher than intussusceptive angiogenesis in both controls and accelerated subglottic injury animals. The overall intra-class correlation coefficient for the two observers counting vessels was .999, indicating very high reliability.

Bottom Line: The subglottic region was evaluated using scanning electron microscopy looking for angiogenic and hypoxic or degenerative features and groups were compared using Mann-Whitney tests and Friedman's 2-way ANOVA.Amongst hypoxic/degenerative features, extravasation was the only feature that was significantly higher in the accelerated subglottic injury group (P=.000).Subglottic injury due to intubation and hypoxia may lead to decreased angiogenesis and increased blood vessel damage resulting in extravasation of fluid and a decreased propensity toward wound healing in this animal model.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Purpose: Subglottic stenosis can result from endotracheal tube injury. The mechanism by which this occurs, however, is not well understood. The purpose of this study was to examine the role of angiogenesis, hypoxia and ischemia in subglottic mucosal injury following endotracheal intubation.

Methods: Six Yorkshire piglets were randomized to either a control group (N=3, ventilated through laryngeal mask airway for corrosion casting) or accelerated subglottic injury group through intubation and induced hypoxia as per a previously described model (N=3). The vasculature of all animals was injected with liquid methyl methacrylate. After polymerization, the surrounding tissue was corroded with potassium hydroxide. The subglottic region was evaluated using scanning electron microscopy looking for angiogenic and hypoxic or degenerative features and groups were compared using Mann-Whitney tests and Friedman's 2-way ANOVA.

Results: Animals in the accelerated subglottic injury group had less overall angiogenic features (P=.002) and more overall hypoxic/degenerative features (P=.000) compared with controls. Amongst angiogenic features, there was decreased budding (P=.000) and a trend toward decreased sprouting (P=.037) in the accelerated subglottic injury group with an increase in intussusception (P=.004), possibly representing early attempts at rapid revascularization. Amongst hypoxic/degenerative features, extravasation was the only feature that was significantly higher in the accelerated subglottic injury group (P=.000).

Conclusions: Subglottic injury due to intubation and hypoxia may lead to decreased angiogenesis and increased blood vessel damage resulting in extravasation of fluid and a decreased propensity toward wound healing in this animal model.

Show MeSH
Related in: MedlinePlus