Untoward sequelae of prolonged intubation

Gaynor, Edward B.; Greenberg, Sheldon

doi:10.1288/00005537-198512000-00005

Cited by 88 publications

(70 citation statements)

References 35 publications

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“…The presence of comorbidities, such as diabetes mellitus, gastroesophageal reflux, and immunosuppression, have also been shown to predispose patients to develop stenosis. 17,20,78,79 Therefore, this population would perhaps benefit from early tracheotomy. 78 The reported historical incidence of laryngotracheal stenosis after endotracheal intubation ranges from 1 to 21%, 76,80 but it is hoped that increasing knowledge about how to limit airway injury from prolonged intubation will reduce these rates.…”

Section: Larynxmentioning

confidence: 99%

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: Larynxmentioning

confidence: 99%

Complications of Airway ManagementDiscussion

Pacheco-Lopez¹,

Berkow

Hillel³

et al. 2014

Respir Care

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“…Prolonged intubation, or intubation occurring for more than 4 days [2], is commonly associated with some serious but oftentimes mild complications. One such mild complaint, tongue swelling, is ubiquitous for those undergoing surgical procedures and has previously been reported [3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Patients may also present with apparent lingual swelling after extubation due to sialadenitis from submandibular duct obstruction by the endotracheal tube or traumatic intubation causing a sublingual hematoma [7,8]. Other mild complications of prolonged intubation include difficulty with phonation and dysphagia after extubation [9], while more serious complications include laryngeal injury and upper airway distress requiring advanced airway management [2,10]. Ischemic necrosis of the tongue in intubated patients is rare and previously reported in patients with cardiogenic shock requiring pressor support or those undergoing prolonged neurosurgical or head and neck surgeries [11,12].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Lingual Necrosis Secondary to Prolonged Endotracheal Intubation

Haider¹,

Kumar²,

Cramer³

et al. 2016

J Med Cases

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We present a unique case of partial necrosis and cleft of the tongue caused by an endotracheal tube, and highlight the importance of endotracheal tube positioning in patients requiring prolonged intubation. A 53-year-old woman underwent endotracheal intubation secondary to respiratory failure due to altered mental status caused by alcohol intoxication. After extubation, she complained of tongue pain and was found to have cleft tongue and necrosis secondary to prolonged intubation. On follow-up, the patient's tongue pain improved with oral analgesics and the tongue was well healed on examination. Tongue necrosis due to compression by an endotracheal tube during prolonged intubation is unusual; however, those involved in the care of intubated patients should consider the potential for this complication. This unique case of tongue necrosis highlights the importance of proper endotracheal tube positioning during prolonged intubation.

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“…When pressure from the firm walls of the tube exceeds capillary pressure in the mucosa of the larynx, mucosal ischemia causes pain, swelling, and redness within the first few hours (Gaynor and Greenberg, 1985). 3 Capillary perfusion pressure is the critical concern in mucosal injury -ischemic necrosis gives rise to epithelial damage and ulceration, the basic lesions from which complications occur (Weymuller, 1988).…”

Section: Pathogenesismentioning

confidence: 99%

Changes in Larynx and Trachea in Postintubated Patients

B¹,

Ramesh²

2015

jemds

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Present critical care units have a significant number of patients who require intubation for prolonged periods of time. With the advent of high volume low-pressure tubes, it is common for the patients to be ventilated through the endotracheal tube for up to 3 weeks in the ICU. The sequelae of intubation depend on multiple factors and can also at times be a major source of morbidity to the patient during recovery. Laryngeal complications after prolonged intubations have varied incidence rates in the literature. Hoarseness of voice, cough, dysphagia, aspiration and stridor can develop after extubation. Common injuries following long-term intubation can manifest in the form of edema, ulceration, granulomas, arytenoid dislocations, adhesions, subglottic stenosis and vocal fold immobility, etc. This study conducted in our ENT Department is based on cases with changes in larynx and trachea following prolonged intubation in Intensive Care Units of Government General Hospital, attached to Rangaraya Medical College, Kakinada, during a period of about two years (September 2011 to August 2013. In our study, 20 patients (66.67%) had lesions only in larynx and 10 patients (33.33%) had lesions in both larynx and trachea. Laryngotracheal sequelae in long-term intubation which showed the increased incidence of complications in patients with more than 10-14 days intubation.

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Untoward sequelae of prolonged intubation

Cited by 88 publications

References 35 publications

Complications of Airway ManagementDiscussion

Complications of Airway ManagementDiscussion

A Rare Case of Lingual Necrosis Secondary to Prolonged Endotracheal Intubation

Changes in Larynx and Trachea in Postintubated Patients

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