Alexander Gelbard
Last active: 7/30/2020

Incidence and Outcomes of Acute Laryngeal Injury After Prolonged Mechanical Ventilation.

Shinn JR, Kimura KS, Campbell BR, Sun Lowery A, Wootten CT, Garrett CG, Francis DO, Hillel AT, Du L, Casey JD, Ely EW, Gelbard A
Crit Care Med. 2019 47 (12): 1699-1706

PMID: 31634236 · DOI:10.1097/CCM.0000000000004015

OBJECTIVES - Upper airway injury is a recognized complication of prolonged endotracheal intubation, yet little attention has been paid to the consequences of laryngeal injury and functional impact. The purpose of our study was to prospectively define the incidence of acute laryngeal injury and investigate the impact of injury on breathing and voice outcomes.

DESIGN - Prospective cohort study.

SETTING - Tertiary referral critical care center.

PATIENTS - Consecutive adult patients intubated greater than 12 hours in the medical ICU from August 2017 to May 2018 who underwent laryngoscopy within 36 hours of extubation.

INTERVENTIONS - Laryngoscopy following endotracheal intubation.

MEASUREMENTS AND MAIN RESULTS - One hundred consecutive patients (62% male; median age, 58.5 yr) underwent endoscopic examination after extubation. Acute laryngeal injury (i.e., mucosal ulceration or granulation tissue in the larynx) was present in 57 patients (57%). Patients with laryngeal injury had significantly worse patient-reported breathing (Clinical Chronic Obstructive Pulmonary Disease Questionnaire: median, 1.05; interquartile range, 0.48-2.10) and vocal symptoms (Voice Handicap Index-10: median, 2; interquartile range, 0-6) compared with patients without injury (Clinical Chronic Obstructive Pulmonary Disease Questionnaire: median, 0.20; interquartile range, 0-0.80; p < 0.001; and Voice Handicap Index-10: median, 0; interquartile range, 0-1; p = 0.005). Multivariable logistic regression independently associated diabetes, body habitus, and endotracheal tube size greater than 7.0 with the development of laryngeal injury.

CONCLUSIONS - Acute laryngeal injury occurs in more than half of patients who receive mechanical ventilation and is associated with significantly worse breathing and voicing 10 weeks after extubation. An endotracheal tube greater than size 7.0, diabetes, and larger body habitus may predispose to injury. Our results suggest that acute laryngeal injury impacts functional recovery from critical illness.

MeSH Terms (16)

Acute Disease Adult Aged Female Humans Incidence Intubation, Intratracheal Larynx Male Middle Aged Prospective Studies Respiration, Artificial Respiration Disorders Time Factors Voice Disorders Wounds and Injuries

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