Prognostic factors in laryngotracheal injury following intubation and/or tracheotomy in ICU patients.
The aim of this study was to determine the incidence of laryngotracheal injuries following intubation and/or tracheotomy in intensive care unit (ICU) patients and to analyze their prognostic factors. This prospective study includes the clinical data and endoscopic exploration of 654 ICU patients who underwent oro-tracheal intubation between September 1992 and February 1999. The prognostic factors for upper airway injuries were analyzed using a multivariate statistical study. Endoscopic exploration of the upper airway 6 to 12 months after extubation revealed laryngotracheal injuries in 30 of the 280 patients examined (11%). The most important factors influencing the development of laryngotracheal lesions were the duration of the oro-tracheal intubation and the length of time in the ICU. Patients at high risk of developing injuries were those with pathological background, a non-neurological or non-surgical (medical) admission or upper-airway injuries at an early stage. The length of oro-tracheal intubation is the most important factor in the development of laryngotracheal injuries. Consequently, it is essential to establish a time limit to perform tracheotomy in ICU patients. Such timing should be adapted to each patient and pathology.
Esteller-Moré
E
E
ENT Department, Hospital General de Catalunya, Cugat del Vallés, Barcelona, Spain. esteller@abaforum.es
Ibañez
J
J
Matiñó
E
E
Ademà
J M
JM
Nolla
M
M
Quer
I M
IM
D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods* / Q000706:statistics & numerical data*; D007830:Larynx / Q000293:injuries*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate; D014132:Trachea / Q000293:injuries*; D014140:Tracheotomy / Q000379:methods* / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality