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VOLUME 10 , ISSUE 3 ( July, 2006 ) > List of Articles

RESEARCH ARTICLE

Laryngeal sequelae following prolonged intubation: A prospective study

V. Rangachari, I. Sundararajan, V. Sumathi, K.Krishna Kumar

Keywords : Endotracheal intubation, laryngeal injury, laryngeal video endoscopy

Citation Information : Rangachari V, Sundararajan I, Sumathi V, Kumar K. Laryngeal sequelae following prolonged intubation: A prospective study. Indian J Crit Care Med 2006; 10 (3):171-175.

DOI: 10.4103/0972-5229.27858

License: CC BY-ND 3.0

Published Online: 01-07-2006

Copyright Statement:  Copyright © 2006; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Laryngeal injuries following intubation have a reported incidence from 63 to 94% and permanent sequelae are reported to be about 10 to 22% in the world literature. While several studies assessing the laryngeal complications are available in Caucasoid populations, minimal data is available in the literature regarding south Indian population. Aim: The aim of this study was to evaluate laryngeal lesions in patients after prolonged intubation (>24 h), to correlate these lesions with the variables involved in the process of intubation and to determine the risk factors. Materials and Methods: This is a prospective study for 1 year of patients who were intubated for more than 24 h in our critical care unit. Patients underwent laryngeal video endoscopy on the day of extubation and after 3 weeks by an ENT surgeon who was blinded to the intubation variables. Result: About 51 patients were included in the study. Laryngeal abnormalities were seen in 41 patients on the day of extubation. At the end of third week after extubation, only 10 patients had abnormal laryngeal findings. A multivariate stepwise regression model showed that bigger tube size (P =0.02), longer duration of intubation (P =0.01) and emergency intubation (P = 0.02) was associated with higher incidence of laryngeal complications on the day of extubation. At the end of third week laryngeal findings were influenced only by the duration of intubation (P =0.001). Conclusion: Laryngeal sequelae after extubation is directly associated with duration of intubation.


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  1. Rudert H. Uncommon injuries of the larynx following intubation. Recurrent paralysis, torsion and luxation of the cricoarytenoid joints. HNO 1984;32:393-8.
  2. Rieger A, Hass I, Gross M, Gramm HJ, Eyrich K. Intubation trauma of the larynx: A literature review with special reference to arytenoid cartilage dislocations. Anasthesiol Intensivmed Notfallmed Schmerzther 1996;31:281-7.
  3. Obrebowski A, Wojnowski W. Hoarseness resulting from post-intubation arytenoid cartilage subluxation in an 11-year-old girl. Otolaryngol Pol 1998;52:223-6.
  4. Lundy DS, Casiano RR, Shatz D, Reisberg M, Xue JW. Laryngeal injuries after long-term intubation. J Voice 1998;12:360-5.
  5. Santos PM, Afrassiabi A, Weymuller EA Jr. Risk factors associated with prolonged intubation and laryngeal injury. Otolaryngol Head Neck Surg 1994;111:453-9.
  6. Panda NK, Mann SB, Raja BA, Batra YK, Jindal SK. Fibreoptic assessment of post intubation laryngotracheal injuries. Indian J Chest Dis Allied Sci 1998;38:241-7.
  7. Benjamin B. Prolonged intubation injuries of the larynx: Endoscopic diagnosis, classification and treatment. Annal Otol Rhinol Laryngol Suppl 1993;160:1-15.
  8. Colice GL. Resolution of laryngeal injury following translaryngeal intubation. Am Rev Respir Dis 1992;145:361-4.
  9. Rajagopalan R, Rajaram R, Pai M, Mahendran S, Praveen RJ, Baskaran A. Incidence and risk factors of post-extubation stridor in a cohort of adult intensive care patients in South India (abstract). Indian J Crit Care Med 1999;3:75-6.
  10. Kastanos N, Estopa Micro R, Marin Perez A, Xaubet Mir A, Augusti-Vidal A. Laryngotracheal injury due to endotracheal intubation: Incidence, evolution and predisposing factors: A prospective long-term study. Crit Care Med 1983;11:362-7.
  11. Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC. Timing of tracheostomy as a determinant of weaning success in critically ill patients: A retrospective study Crit Care 2005;9:R46-52.
  12. Ellis SF, Pollak AC, Hanson DG, Jiang JJ. Videolaryngoscopic evaluation of laryngeal intubation injury: Incidence and predictive factors. Otolaryngol Head Neck Surg 1996;114:729-31.
  13. Volpi D, Lin PT, Kuriloff DB, Kimmelman CP. Risk factors for intubation injury of the larynx. Annal Otol Rhinol Laryngol 1987;96:684-6.
  14. Granja C, Faraldo S, Laguna P, Gois L. Control of the endotracheal cuff balloon pressure as a method of preventing laryngotracheal lesions in critically ill intubated patients. Rev Esp Anestesiol Reanim 2002;49:137-40.
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