Laryngotracheal injury due to endotracheal intubation

Kastanos, Nikos; Miró, Ramón; Perez, Alberto MarÍn; Mir, Antonio Xaubet; Agustí-Vidal, A

doi:10.1097/00003246-198305000-00009

Cited by 219 publications

(31 citation statements)

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“…Endotracheal intubation can cause damage to the oropharynx, larynx and trachea [2,17-21]. Laryngeal edema and mucosal ulcerations occur in almost all patients intubated for 4 days or more [2,19,20].…”

Section: Etiology and Pathogenesismentioning

confidence: 99%

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

et al. 2009

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Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post-extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. Laryngeal edema may compromise the airway necessitating reintubation. Several studies show that a positive cuff leak test combined with the presence of risk factors can identify patients with increased risk for laryngeal edema. Meta-analyses show that pre-emptive administration of a multiple-dose regimen of glucocorticosteroids can reduce the incidence of laryngeal edema and subsequent reintubation. If post-extubation edema occurs this may necessitate medical intervention. Parenteral administration of corticosteroids, epinephrine nebulization and inhalation of a helium/oxygen mixture are potentially effective, although this has not been confirmed by randomized controlled trials. The use of non-invasive positive pressure ventilation is not indicated since this will delay reintubation. Reintubation should be considered early after onset of laryngeal edema to adequately secure an airway. Reintubation leads to increased cost, morbidity and mortality.

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Section: Etiology and Pathogenesismentioning

confidence: 99%

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

et al. 2009

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“…Several factors influence cuff pressure, including quantity of air injected in the cuff [30], the ratio between cuff and tracheal diameter, cuff physical characteristics [31], patient temperature [32], airway pressure [11], and patient position [33]. Other risk factors for tracheal ischemia include hypotension [34], hypoxemia [27,35], inflammation [36], and subglottic secretion drainage [37,38] (Figure 2). Seegobin and van Hasselt [29] performed a prospective study in 40 patients intubated with a high-volume low-pressure cuffed tracheal tube for surgery under general anesthesia.…”

Section: Reviewmentioning

confidence: 99%

“…An animal study demonstrated that tracheal ischemia was substantially increased by hypotension [34]. Further, two clinical studies found hypoxemia to increase the severity of tracheal injury [27,35]. Another suggested mechanism for tracheal ischemia is inflammation resulting from the presence of the tracheal tube, and repeated ischemia-reperfusion [36].…”

Section: Reviewmentioning

confidence: 99%

Optimal care and design of the tracheal cuff in the critically ill patient

Jaillette

Martín‐Loeches

Artigas

et al. 2014

Ann. Intensive Care

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Despite the increasing use of non-invasive ventilation and high-flow nasal-oxygen therapy, intubation is still performed in a large proportion of critically ill patients. The aim of this narrative review is to discuss recent data on long-term intubation-related complications, such as microaspiration, and tracheal ischemic lesions. These complications are common in critically ill patients, and are associated with substantial morbidity and mortality. Recent data suggest beneficial effects of tapered cuffed tracheal tubes in reducing aspiration. However, clinical data are needed in critically ill patients to confirm this hypothesis. Polyurethane-cuffed tracheal tubes and continuous control of cuff pressure could be beneficial in preventing microaspiration and ventilator-associated pneumonia (VAP). However, large multicenter studies are needed before recommending their routine use. Cuff pressure should be maintained between 20 and 30 cmH2O to prevent intubation-related complications. Tracheal ischemia could be prevented by manual or continuous control of cuff pressure.

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“…Lindholm's work clearly indicated that laryngeal damage after TLI for 1 to 2 days was well tolerated clinically. [86], but tended to be a manageable problem. Several authors [42,85] stated that the larynx tolerates TLI well, with few serious clinical complications, for periods of up to 2 to 3 weeks.…”

Section: Historical Developmentmentioning

confidence: 99%

“…Inward collapse of the lateral and anterior tracheal walls is a consequence of this fibrotic healing process and results in a triangular narrowing of the tracheal orifice [145,147,148,[151][152][153] (Fig 10). Many studies have shown that tracheal stenosis at the stoma commonly occurs after decannulation and stomal closure [35,42,77,86,145,146,149,[154][155][156][157]. Arola and colleagues [150] showed that some degree of stomal stenosis occurs in 85% of patients after tracheostomy decannulation.…”

Section: Important Clinical Laryngeal Complications Of Translaryngealmentioning

confidence: 99%

Prolonged Intubation Versus Tracheostomy in the Adult

Colice

1987

J Intensive Care Med

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The development of mechanical ventilators that can en sure adequate respiration for long periods of time has led to the problem of determining how to best integrate patients into the machine's airflow circuits. Tracheal tubes with inflatable cuffs efficiently connect the patient to the machine, but the tubes may be placed in one of two ways. Each option has relative advantages and disad vantages. Translaryngeal intubation (TLI) can be per formed safety and quickly and is the preferred first step in airway management. However, when TLI is needed for prolonged periods, it may damage the larynx. Tra cheostomy, on the otherhand, has potential operative and tracheal complications, but presents little risk to the larynx and may be better tolerated by the patient requir ing long-term intubation. This review provides a histor ical background of these two methods and analyzes their respective advantages and complications. Guide lines for the optimal use of TLI and tracheostomy, par ticularly in adult patients requiring long-term intuba tion, are developed by comparing the risks and benefits of these two methods.

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Laryngotracheal injury due to endotracheal intubation

Cited by 219 publications

References 0 publications

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

Optimal care and design of the tracheal cuff in the critically ill patient

Prolonged Intubation Versus Tracheostomy in the Adult

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