Complications and late sequelae following nasotracheal intubation

Abstract

A total of 379 patients admitted to the ICU for mechanical ventilation were prospectively investigated for lesions on the nose, nasal cavity, ears and larynx during and after nasotracheal intubation. One to two years later, the surviving patients were questioned to investigate late persisting sequelae. During intubation and up to 5 days following extubation, inflammatory changes and ulceration of the nostrils or nasal septum were found in 76 (20%) and 110 patients (29%), respectively. There were bleedings from the nasal cavity in 67 (19%) and fractures of the conchae in 40 patients (11%). Hoarseness was noted in 135 patients (42%). Inflammatory changes and ulcerations of the nostril and nasal septum were correlated to the duration of intubation. Among the 281 patients included in the follow-up study, 100 (35%) had symptoms from the nose and nasal cavity. Sixty-five (24%) had symptoms related to the ears, 56 (20%) to the maxillary sinus, 81 (29%) to the voice and 90 (32%) to the throat. Increasing duration of intubation was found to be correlated to persisting symptoms from the larynx. Former ulcerations of the nose were associated with a tendency to nasal bleeding. To avoid as many complications as possible from the nose and nasal cavity, we recommend orotracheal intubation. As late sequelae from the larynx increase with the duration of intubation, perhaps tracheostomy should be performed earlier than is general practice today, but that has to be proven in forthcoming studies.

Single‐stage preputial skin flap urethroplasty for long‐segment urethral strictures: evaluation and determinants of success

“…Regional anaesthesia, in the form of a spinal or an epidural block, is usually preferred as both the donor and recipient sites are in the same region of the body and supplied by similar nerve roots. General anaesthesia , with or without nasal intubation , and its attendant complications can therefore be avoided.…”

Intrapleural placement of a nasogastric tube: an unusual complication of nasotracheal intubation

“…17 In practice, however, this complication is uncommon. Neither oesophageal nor pharyngeal perforation was reported as a complication in two recent, large patient series after nasotracheal intubation.~8, 19 In a recent series of 52 cases of oesophageal perforation, however, three perforations secondary to emergency blind nasotracheal intubation were reported.I~ Since the prognosis of oesophageal perforation depends greatly on rapid diagnosis and treatment, 3,4 it is important to review the sensitivity of traditional clinical manoeuvres in the detection of nasogastric tube misplacement and oesophageal rupture. Since this complication occurs in the setting of anaesthetized or sedated patients, clinical evidence that a problem has occurred may be minimal.…”

Otorhinolaryngological problems occurring within the intensive care unit

“…Nasal injuries resulting from endonasal tubes are common. They include ulcerations of the nostrils and septum and fractures of the turbinates [28]. These injuries can easily lead to adhesions and subsequent nasal obstruction, or to infection, ranging from local to cavernous sinus thrombosis.…”