Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-08T07:27:29.356Z Has data issue: false hasContentIssue false
  • English
  • Français

Post intubation laryngeal sequelae in an intensive care unit

Published online by Cambridge University Press:  29 June 2007

Ratna Thomas ,
E. Vijaya Kumar ,
Mohan Kameswaran ,
Ahmed Shamim ,
Saeed Al Ghamdii ,
Anil P. Mummigatty.  and
B. C. Okafor
Ratna Thomas
Affiliation:
Department of OtolaryngologyAsir Central Hospital, Abha
E. Vijaya Kumar
Affiliation:
Departments of AnaesthesiologyCollege of Medicine, King Saud University, Abha
Mohan Kameswaran*
Affiliation:
Departments of Otolaryngology, College of Medicine, King Saud University, Abha.
Ahmed Shamim
Affiliation:
Department of OtolaryngologyAsir Central Hospital, Abha
Saeed Al Ghamdii
Affiliation:
Departments of Otolaryngology, College of Medicine, King Saud University, Abha.
Anil P. Mummigatty.
Affiliation:
Departments of Otolaryngology, College of Medicine, King Saud University, Abha.
B. C. Okafor
Affiliation:
Departments of Otolaryngology, College of Medicine, King Saud University, Abha.
*
Address for correspondence: Dr Mohan Kameswaran, 458. IIIrd Avenue, Indira Nagar, Adayar. Madras 600020, India.
Get access Rights & Permissions [Opens in a new window]

Abstract

The incidence, severity and pattern of post-intubation laryngotracheal sequelae in a 12 bed multidisciplinary intensive care unit (ICU) were assessed in this prospective study. One-hundred and fifty consecutive patients requiring intubation for more than 24 hours for various indications were studied. Evaluation of the larynx and trachea was done using a fibreoptic bronchoscope introduced through the endotracheal tube prior to elective extubation. Rigid bronchoscopy and direct laryngoscopy were performed in very small children and adults requiring tracheostomy. One-hundred and thirty-one (87.6 per cent) patients had visible laryngeal pathology in the immediate post-extubation period. Thirteen (8.6 per cent) had long term sequelae. A high incidence of long term sequelae was noted in patients with seizures (25 per cent) followed by patients with head injury (19 per cent). Steroid therapy failed to offer any significant protection but resulted in doubling of pulmonary sepsis. A grading system was adopted to classify acute laryngotracheal injury and a significant correlation was found between the presence of slough in the immediate post-extubation period and subsequent development of long term sequelae. There was also a significant correlation between a deeper insertion of the endotracheal tube and development subsequently of long term sequelae. The significance of these findings is discussed.

Keywords

Intubationintratrachealcomplications
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 109 , Issue 4 , April 1995 , pp. 313 - 316
Copyright
Copyright © JLO (1984) Limited 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Balestrieri, F., Watson, C. B. (1982) Intuhation granuloma. Otolaryngological Clinics of North America 15: 567–579.CrossRefGoogle ScholarPubMed
Barbet, J. P., Chauveau, M., Labbe, S., Lockhart, A. (1988) Breathing dry air causes acute epithelial damage and inflammation of the guinea pig trachea. Journal of Applied Physiology 64: 1851–1857.CrossRefGoogle ScholarPubMed
Burns, H. P., Dayal, V. J., Scott, A. (1979) Laryngotracheal trauma: observations on its pathogenesis and its prevention following prolonged orotracheal intubation in the adult. Laryngoscope 89: 1316–1326.CrossRefGoogle ScholarPubMed
Dunham, C. M., La Monica, C. (1984) Prolonged tracheal intubation in the trauma patient. Journal of Trauma 24: 120–124.CrossRefGoogle ScholarPubMed
El Naggar, M., Sadagopan, S., Levine, H., Kantor, H., Collins, V. J. (1976) Factors influencing choice between tracheostomy and prolonged translaryngeal intubation in acute respiratory failure. Anesthesia Analgesia 55: 195–201.CrossRefGoogle ScholarPubMed
Gaynor, E. B., Greenberg, S. B., Norwalk, C. T. (1985) Untoward sequelae of prolonged intubation. Laryngoscope 95: 1461–1467.CrossRefGoogle ScholarPubMed
Geffin, R., Grillo, H. C., Cooper, J. D., Pontoppidan, H. (1971) Stenosis following tracheostomy for respiratory care. Journal of American Medical Association 216: 1984–1988.CrossRefGoogle ScholarPubMed
Lewis, E R., Schlobohm, R. M., Thomas, A. N. (1978) Prevention of complications from prolonged tracheal intubation. American Journal of Surgery 135: 452–457.CrossRefGoogle ScholarPubMed
Morriss, F. C. (1984) Post Intubation Sequelae. In A Practical guide to Pediatric Intensive Care. (Levin, D. L., Morriss, F. C., Moore, G. C., eds.). CV Mosby. St. Louis. pp 191–196.Google Scholar
Nowak, P., Cohn, A. M., Guidice, M. A. (1987) Airway complications in patients with closed head injuries. American Journal of Otolaryngology 8: 91–96.CrossRefGoogle ScholarPubMed
O'Neill, J. A. (1984) Experience with latrogenic laryngeal and tracheal stenosis. Journal of Pediatric Surgery 19: 235–238.CrossRefGoogle Scholar
Pontoppidan, H., Geffin, B., Lowenstein, E. (1972) Acute respiratory failure in the adult. New England Journal of Medicine 287: 799–806.CrossRefGoogle ScholarPubMed
Sprucance, J. S., Reilly, J. S., Doyle, W. J. (1982) Acquired subglottic stenosis following prolonged endotracheal intubation. Archives of Orolaryngology 108: 727–732.Google Scholar
Stauffer, J. L., Olson, D. E., Petty, T. L. (1981) Complication and consequences of endotracheal intubation and tracheostomy. A prospective study of 150 critically ill adult patients. The American Journal of Medicine 70: 65–75.CrossRefGoogle Scholar
Squire, R., Brodsky, L., Rossman, J. (1990) The role of infection in the pathogenesis of acquired tracheal stenosis. Laryngoscope 100: 765–770.CrossRefGoogle ScholarPubMed
Tonkin, J. P., Harrison, E. A. (1967) The effect on the larynx of prolonged endotracheal intubation. Medical Journal of Australia 2: 581–587.CrossRefGoogle Scholar
Whited, R. E. (1984) A prospective study of laryngotracheal sequelae in long term intubation. Larvngoscope 94: 367–377.CrossRefGoogle ScholarPubMed
Zalzal, G. H., Luyten, F. (1992) An invirro model for studying growth and effect of trauma and external agents on the cricoid at the cellular level. Archives of Otolaryngology – Head and Neck Surgery 118 (4): 407–411.CrossRefGoogle ScholarPubMed