Risk Factors Associated with Prolonged Intubation and Laryngeal Injury

Abstract

A prospective study evaluated potential risk factors associated with laryngeal injury after prolonged endotracheal tube intubation for longer than 3 days. Ninety-seven patients were evaluated after oral endotracheal tube intubation (mean, 9 days). This study updates a previously reported evaluation of 44 patients. The additional sample size has provided findings of unreported patient risk factors of laryngeal injury and confirmation of previous associations. The majority of the 97 patients had some type of laryngeal injury, ranging from mild mucosal erythema to ulceration, granuloma formation, or true vocal cord immobility. Patient examinations were continued until the larynx returned to normal or stabilized or the patient was lost to follow-up. Postextubation examinations in the survival group revealed the following. (1) Laryngeal erythema occurred in 94%, and ulceration occurred in 76% of the patients with resolution within 6 weeks. (2) Laryngeal granulomas occurred in 44% of the patients; the majority of the granulomas (57%) developed an average of 4 weeks after extubation. Associated risk factors included duration of endotracheal tube intubation (p < 0.05) and presence of nasogastric tube (p < 0.05). (3) Vocal cord immobility was observed in 16 patients (20%). Eight patients had true vocal cord immobility noted initially after extubation, and the remaining eight had true vocal cord immobility an average of 4 weeks after extubation. Initial and delayed true vocal cord immobility were associated with duration of intubation and size of endotracheal tube (p < 0.01). Delayed true vocal cord immobility developed only in patients with a size 8 endotracheal tube.(ABSTRACT TRUNCATED AT 250 WORDS)

Complications of Airway ManagementDiscussion

“…Ninety-seven percent of intubations, even for very brief periods, may lead to some form of laryngeal injury. 12,48,49 Injuries may include vocal cord erythema, ulcers, granulomas, and, less commonly, vocal cord immobility. 48 After being extubated, many patients have transient complaints of vocal fatigue, dysphagia, sore throat, hoarseness, throat clearing, and aspiration.…”

“…12,48,49 Injuries may include vocal cord erythema, ulcers, granulomas, and, less commonly, vocal cord immobility. 48 After being extubated, many patients have transient complaints of vocal fatigue, dysphagia, sore throat, hoarseness, throat clearing, and aspiration. Hamdan et al 50 studied the short-term effects of intubation on voice and found that the most important variables associated with an increase in vocal symptoms were mean cuff pressure and volume.…”

Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

“…Pathological findings include superficial abrasions of the mucosa and desquamated necrotic tracheal epithelium. 2 Several factors have been proposed that predispose patients to tracheal injury after intubation 4 ; however, the risk factors for OFTP remain difficult to ascertain due to the rarity of the condition. We postulate that diabetes may have been a contributing factor to the development of OFTP in this subject, as microcirculatory changes in diabetes that are well described may directly affect tissue healing.…”

Dyspnea Associated with Vocal Cord Paralysis and Type-2 Chiari Malformation

“…There is a danger of vocal cord paralysis and vocal cord dysfunction. The relation between prolonged intubation and an increased risk of vocal cord immobility and injury was clear (6). Placement of the tracheal tube is thought to immobilize the vocal cords and muscles and paralyse the peripheral nerves (7).…”