Persistent Features of Laryngeal Injury Following Endotracheal Intubation: A Systematic Review

Kelly, Eileen; Hirschwald, Julia; Clemens, Julie; Regan, Julie

doi:10.1007/s00455-023-10559-0

Cited by 5 publications

(6 citation statements)

References 41 publications

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“…The laryngeal examinations were performed within 6 h to 2 weeks after extubation in these studies. Research examining long-term follow-up of laryngeal function after intubation and ICU treatment is lacking [ 45 ]. In a recent review, Kelly and co-authors [ 45 ] identified no long-term studies of persistent features of laryngeal injury in non-COVID-19 patients treated in the ICU.…”

Section: Discussionmentioning

confidence: 99%

Long-term effects on swallowing and laryngeal function after treatment for severe COVID-19 disease in intensive care

Dotevall,

Tuomi,

Lindell

et al. 2024

Eur Arch Otorhinolaryngol

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Purpose This study aimed to assess swallowing and laryngeal function at long-term follow-up in patients treated for severe COVID-19 in the ICU. Methods Thirty-six patients with severe COVID-19 were prospectively examined with fiberendoscopic evaluation of swallowing (FEES) about 6 and 12 months after ICU discharge. Comparison with initial FEES examinations during the time in hospital was performed in 17 patients. Analysis of swallowing function and laryngeal features was performed from video recordings. Twenty-five participants responded to Eating Assessment Tool, Voice Handicap Index, and the Hospital Anxiety and Depression Scale at follow-up. Results Penetration to the laryngeal vestibule (PAS ≥ 3) was seen in 22% and silent aspiration (PAS = 8) in 11% of patients on at least one swallow at follow-up. Fourteen percent had obvious residue in the vallecula and/or pyriform sinuses after swallowing thick liquid or biscuits. Self-reported eating and swallowing difficulties were found in 40% of patients. Abnormal findings in the larynx were present in 53% at follow-up. Thirty-three percent had reduced or impaired vocal fold movement, of whom 22% had bilateral impaired abduction of the vocal folds. Possible anxiety and depression were found in 36% and 24% of responders, respectively. Conclusion Although a majority of patients appear to regain normal swallowing function by 1 year after treatment for severe COVID-19, our results indicate that dysphagia, abnormal laryngeal function, and anxiety/depression may remain in a substantial proportion of patients. This suggests that swallowing and laryngeal function, and emotional symptoms, should be followed up systematically over time in this patient group.

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Section: Discussionmentioning

confidence: 99%

Long-term effects on swallowing and laryngeal function after treatment for severe COVID-19 disease in intensive care

Dotevall,

Tuomi,

Lindell

et al. 2024

Eur Arch Otorhinolaryngol

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“…In our study, tracheostomy was delayed in 100% of cases (beyond 7 days) with an average of 16.35 days. This could be one of the hypotheses for the appearance of more lesions after intubation in this type of patient than in others intubated for another pathology in other periods outside the COVID-19 pandemic ( Table 6 ) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 23 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review presented by Kelly et al [ 46 ] included six cohorts and a total number of 436 patients. Persistent features of laryngotracheal complication identified were airway abnormalities (18.9–27%), dysphonia (13.2–60%) and dysphagia (23–33%).…”

Section: Discussionmentioning

confidence: 99%

“…The factors presenting statistical significance for the development of laryngotracheal lesions were the endotracheal tube size; prone position over the ETI period; and the increased leukocyte count, D-dimer, prothrombin time (PT), and international normalized ratio (INR) on the day ETI was performed. A recent systematic review presented by Kelly et al [46] included six cohorts and a total number of 436 patients. Persistent features of laryngotracheal complication identified were airway abnormalities (18.9-27%), dysphonia (13.2-60%) and dysphagia (23-33%).…”

Section: Discussionmentioning

confidence: 99%

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Laryngotracheal Complications after Intubation for COVID-19: A Multicenter Study

Hernández-García,

Hernández-Sandemetrio,

Quintana-Sanjuás

et al. 2023

Life

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Many of the patients with COVID-19 have suffered respiratory distress requiring prolonged endotracheal intubation (ETI) resulting in laryngotracheal complication with an impact on breathing, phonation, and swallowing. Our aim is to describe laryngeal injuries diagnosed after ETI in patients with COVID-19 in a multicentre study. Methods: A prospective descriptive observational study was conducted from January 2021 to December 2021, including COVID-19 patients with laryngeal complications due to ETI diagnosed in several Spanish hospitals. We analyzed the epidemiological data, previous comorbidities, mean time to ICU admission and ETI, need for tracheostomy, mean time on invasive mechanical ventilation until tracheostomy or weaning, mean time in ICU, type of residual lesions, and their treatment. Results: We obtained the collaboration of nine hospitals during the months of January 2021 to December 2021. A total of 49 patients were referred. Tracheostomy was performed in 44.9%, being late in most cases (more than 7–10 days). The mean number of days of ETI until extubation was 17.63 days, and the main post-intubation symptoms were dysphonia, dyspnea, and dysphagia, in 87.8%, 34.7%, and 42.9%, respectively. The most frequent injury was altered laryngeal mobility, present in 79.6%. Statistically, there is a greater amount of stenosis after late ETI and after delayed tracheostomy, not observing the data with the immobility alterations. Conclusion: The mean number of days of ETI was long, according to the latest guidelines, with the need for several cycles of pronation. This long ETI may have had an impact on the increase of subsequent laryngeal sequelae, such as altered laryngeal mobility or stenosis.

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“…Studies have shown that some burn injuries result in long-term damage to laryngeal and pharyngeal structures [8][9][10][11]. Burns due to direct thermal contact caused by hot liquids, flames, or steam can directly damage the larynx and pharynx [12].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Self-Reported Voice Change in the Hospitalized Burn Population: A Burn Model System National Database Study

Chacon,

Santos,

McMullen

et al. 2024

EBJ

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Voice plays a prominent role in verbal communication and social interactions. Acute burn care often includes intubation, mechanical ventilation, and tracheostomy, which could potentially impact voice quality. However, the issue of long-term dysphonia remains underexplored. This study investigates long-term self-reported voice changes in individuals with burn injuries, focusing on the impact of acute burn care interventions. Analyzing data from a multicenter longitudinal database (2015–2023), self-reported vocal changes were examined at discharge and 6, 12, 24, and 60 months after injury. Out of 582 participants, 65 reported voice changes at 12 months. Changes were prevalent at discharge (16.4%) and persisted over 60 months (11.6–12.7%). Factors associated with voice changes included flame burn, inhalation injury, tracheostomy, outpatient speech-language pathology, head/neck burn, larger burn size, mechanical ventilation, and more ventilator days (p < 0.001). For those on a ventilator more than 21 days, 48.7% experience voice changes at 12 months and 83.3% had received a tracheostomy. The regression analysis demonstrates that individuals that were placed on a ventilator and received a tracheostomy were more likely to report a voice change at 12 months. This study emphasizes the need to understand the long-term voice effects of intubation and tracheostomy in burn care.

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Persistent Features of Laryngeal Injury Following Endotracheal Intubation: A Systematic Review

Cited by 5 publications

References 41 publications

Long-term effects on swallowing and laryngeal function after treatment for severe COVID-19 disease in intensive care

Long-term effects on swallowing and laryngeal function after treatment for severe COVID-19 disease in intensive care

Laryngotracheal Complications after Intubation for COVID-19: A Multicenter Study

Factors Associated with Self-Reported Voice Change in the Hospitalized Burn Population: A Burn Model System National Database Study

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