Laryngeal Injury in the Intubated ICU Patient

Abstract

Endotracheal intubation is a regularly used life-saving process for patients brought into hospital emergency rooms. Previous research has indicated that up to 94% of patients who have undergone the endotracheal intubation procedure have sustained laryngeal injuries post extubation (Santos, 1994). However, a number of variables might affect the probability of intubation-related injury, including the size of the tube and the duration of intubation. In addition, patient-related variables such as age or gender may also play a role. The present study analyzed the type and frequency of endotracheal intubation-related injuries among patients in the Ohio State University Intensive Care Unit. In this study, 27 patients who had been intubated for longer than 24 hours underwent a videoendoscopy procedure within 48 hours of extubation. The videos were presented in a single-blind procedure to an experienced laryngeal endoscopist, such that the endoscopist was not informed regarding any details of the videos. The expert rated the degree of complications seen from the videoendoscopy procedure, indicating “yes” or “no” to the presence of vocal cord paresis/paralysis, glottic web formation, and laryngeal granuloma. The expert also rated both vocal cord erythema and laryngeal ulceration on a scale of 0-3: 0 = normal, 1 = 0-5mm, 2 = 6-10mm, and 3 = >10mm. Results indicated that all but two subjects exhibited laryngeal pathology consistent with intubation trauma. These findings did not correlate in frequency of occurrence or in severity as a function of duration of intubation, size of endotracheal tube, gender, or age. Three of the patients did require re-intubation, and all three subsequently developed laryngeal paralysis. This last finding reinforces careful selection of patients for extubation so that re-intubation may be avoided.