Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study

Tadié, Jean‐Marc; Behm, E.; Lécuyer, Lucien; Benhmamed, Rania; Hans, Stéphane; Brasnu, Daniel; Diehl, Jean‐Luc; Fagon, Jean-Yves; Guérot, Emmanuel

doi:10.1007/s00134-010-1847-z

Cited by 133 publications

(147 citation statements)

References 35 publications

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“…Female gender also has been suggested as a risk factor for developing postextubation laryngeal edema and subglottic stenosis. [15][16][17] It has been speculated that the laryngotracheal mucosa in men may be more resilient to trauma than that in women and that the dimensions of the larynx and trachea are smaller in women than in men, making them more prone to injury, especially if an inadequately sized tube is used. 18,19 Other studies have found no correlation between laryngeal injury or vocal fold im-mobility after controlling for age, gender, height, and weight.…”

Section: Risk Factorsmentioning

confidence: 99%

“…In fact, the most common cause of adult laryngotracheal stenosis is endotracheal intubation. 75,76 The duration of intubation has been found to correlate significantly with the incidence of laryngeal pathologies, including the development of subglottic edema and narrowing when intubation time exceeds 7 d. 16,77 However, Colton House et al 20 demonstrated no significant difference in the development of subglottic edema regardless of duration of intubation or tube size. The presence of comorbidities, such as diabetes mellitus, gastroesophageal reflux, and immunosuppression, have also been shown to predispose patients to develop stenosis.…”

Section: Larynxmentioning

confidence: 99%

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Complications of Airway ManagementDiscussion

Pacheco-Lopez¹,

Berkow

Hillel³

et al. 2014

Respir Care

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Although endotracheal intubation is commonly performed in the hospital setting, it is not without risk. In this article, we review the impact of endotracheal intubation on airway injury by describing the acute and long-term sequelae of each of the most commonly injured anatomic sites along the respiratory tract, including the nasal cavity, oral cavity, oropharynx, larynx, and trachea. Injuries covered include nasoseptal injury, tongue injury, dental injury, mucosal lacerations, vocal cord immobility, and laryngotracheal stenosis, as well as tracheomalacia, tracheoinnominate, and tracheoesophageal fistulas. We discuss the proposed mechanisms of tissue damage that relate to each and present their most common clinical manifestations, along with their respective diagnostic and management options. This article also includes a review of complications of airway management pertaining to video laryngoscopy and supraglottic airway devices. Finally, potential strategies to prevent intubation-associated injuries are outlined.

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Section: Risk Factorsmentioning

confidence: 99%

Section: Larynxmentioning

confidence: 99%

Complications of Airway ManagementDiscussion

Pacheco-Lopez¹,

Berkow

Hillel³

et al. 2014

Respir Care

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show abstract

“…However, this assumption fails to account for the common occurrence of upper airway edema or laryngeal lesions, 32 which could impose additional work load on patients after extubation. Experimental studies have shown that the work of breathing measured at the end of a 2-h T-piece trial is equivalent to postextubation respiratory load.…”

Section: Sbt Using a T-piece Is Better Than Minimal Pressure Support mentioning

confidence: 99%

Ventilator Liberation for High-Risk-for-Failure Patients: Improving Value of the Spontaneous Breathing Trial

2014

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Several patient populations have been identified as high risk for extubation failure despite successful completion of a spontaneous breathing trial (SBT). Extubation failure and subsequent need for emergent re-intubation have been associated with increased morbidity and mortality. In this review, we discuss ways to optimize the value and performance of the SBT in a subgroup of high-risk patients (elderly, cardiac, and/or respiratory failure) to reduce the rate of extubation failure. We recommend the use of T-piece mode, longer duration SBT, and measurement of the rapid shallow breathing index (breathing frequency/tidal volume in L) off ventilatory support to increase the predictive value of the SBT. In addition, measurement of changes in central venous oxygen saturation and serum brain natriuretic peptide, and measurements of mitral inflow and annular velocity using bedside transthoracic echocardiography with tissue Doppler imaging may help guide the clinician in determining who and when to extubate and thus minimize the rate of extubation failure. Arterial blood gas analysis performed at the end of the SBT may help determine who will benefit from prophylactic use of noninvasive ventilatory support postextubation.

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“…LRN impairment was diagnosed by laryngoscopy. Failure of oxygenation, carbon dioxide clearance, or both of these, associated with an increase in hydrogen ion concentration in the plasma (pH<7.30) were considered as acute respiratory failure [16,17]. Each patient was treated by PSE; if ARF did not recover after the 4 th endoscopic check (8 days), a tracheotomy was placed.…”

Section: Methodsmentioning

confidence: 99%

Nasotracheal Prolonged Safe Extubation Reduces the Need of Tracheotomy in Patients with Acute Respiratory Failure following Thyroidectomy

Ferraro¹

2014

J Anesth Clin Res

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Objectives: Acute respiratory failure (ARF) is a complication following thyroid surgery; its incidence is reported as high as 0.9%. Through an illustrative case series, we present an alternative treatment of this peculiar ARF: the nasotracheal Prolonged Safe Extubation (PSE). Methods:Patients treated at our Intensive Care Unit for ARF following thyroid surgery from January 2004 to December 2009, were reviewed. Demographic data including gender, age, clinical presentation, laryngoscopic findings, management and outcome during a 24-months follow-up after treatment were collected and evaluated. The strategy for prolonged nasotracheal safe extubation is presented.Results: Twelve out of the 1713 patients scheduled for thyroid surgery (0.7%) at our university hospital, developed post-operative ARF. All of them were treated by nasotracheal prolonged safe extubation. The success rate in avoiding highly invasive treatment was of 83.3%, since only 2 patients needed tracheotomy (16.7%). Conclusions:The prolonged safe extubation reduced the amount of expected tracheotomies in patients with ARF following thyroid surgery. Thanks to its minimal invasiveness, and to the high degree of comfort, it was well tolerated.

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Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study

Cited by 133 publications

References 35 publications

Complications of Airway ManagementDiscussion

Complications of Airway ManagementDiscussion

Ventilator Liberation for High-Risk-for-Failure Patients: Improving Value of the Spontaneous Breathing Trial

Nasotracheal Prolonged Safe Extubation Reduces the Need of Tracheotomy in Patients with Acute Respiratory Failure following Thyroidectomy

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