Height is an independent risk factor for postintubation laryngeal injury

Abstract

Objectives/Hypothesis Intubation is an essential component of intensive care, yet it does have potential complications. Posterior glottic stenosis (PGS) is among the most severe sequela. Risk factors are poorly understood. One hypothesis is that large endotracheal tubes (ETTs) in smaller airways may increase risk. Because tracheal diameter is proportional to height, we designed a case‐control study to evaluate the association between intensive care unit (ICU)‐patient height (proxy for tracheal diameter) and their risk of postintubation PGS. Study Design Retrospective case‐control study Methods Among patients who underwent intubation in an ICU at a single tertiary care medical center between 2001 and 2015, a convenience sample of all patients with confirmed PGS (cases) were enrolled. Cases were matched 1:1 by age, sex, and race with intubated non‐PGS controls chosen from the same population of ventilated patients. Data on height, weight, comorbidities, size of ETT, and duration of intubation were abstracted from the medical record. Multivariate models were used to test the association between patient height and risk of PGS development. Results In all, 106 PGS cases (mean age 48.9 years, 50.7% female, 79.2% Caucasian) were identified; 77 met inclusion criteria. Compared to matched controls, cases were significantly shorter (mean 166 cm vs. 173 cm, P = .001). Height and PGS showed an inverse relationship in multivariate models. Specifically, odds of PGS decreased 9% (95% confidence interval: 0.01%‐16%) for each centimeter increase in height. Conclusions Shorter height is independently associated with increased odds of having PGS. Further work should consider whether height should be incorporated into ETT selection algorithms. Level of Evidence 3b Laryngoscope, 128:2811–2814, 2018

Length of the Cricoid and Trachea in Children: Predicting Intubation Depth to Prevent Subglottic Stenosis

“…We found that height alone was the best predictor of SL, which has not previously been reported 23 . Shorter height has been independently associated with increased odds of developing posterior glottic stenosis in intubated adults 36 . Interestingly, sex and presence of a syndrome also did not have an effect beyond that predicted by patient height alone, and the same formula for predicting SL in nonsyndromic children could be used in syndromic children.…”

Laryngeal complications of COVID‐19

“…In addition, patient‐specific risk factors such as comorbid conditions have been associated with increased risk for subsequent laryngotracheal injury following intubation. These factors include type 2 diabetes mellitus, obesity, hypertension, cardiovascular disease, and smoking 38‐40,43,44 . It is thought that these factors may predispose patients to ETT‐induced mucosal injury of the larynx and impaired healing once injury occurs 40 .…”

“…These factors include type 2 diabetes mellitus, obesity, hypertension, cardiovascular disease, and smoking. [38][39][40]43,44 It is thought that these factors may predispose patients to ETT-induced mucosal injury of the larynx and impaired healing once injury occurs. 40 Several of these comorbidities have also been associated with increased severity of COVID-19 infection, 42,45 suggesting that not only are these patients at greater risk of intubation but also at increased risk of subsequent intubation-related laryngeal sequelae.…”

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility

“…This may be secondary to ETT that are too large for shorter patients. 16 Larger multicenter studies may be important for implementing updated algorithms for ETT selection.…”