Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study.
OBJECTIVE
To describe laryngeal injuries after intubation in an intensive care unit and assess their risk factors and their association with post-extubation stridor (PES) and extubation failure.


METHODS
Prospective study including 136 patients extubated after more than 24 h of mechanical ventilation. Fiberoptic endoscopic examination of the larynx was systemically performed within 6 h after extubation in order to record four types of laryngeal anomalies: edema, ulceration, granulation, and abnormal vocal cord (VC) mobility.


RESULTS
Median duration of intubation was 3 days (min 24 h, max 56 days). Laryngeal injuries were frequent (73% of patients) and were associated with duration of intubation [odds ratios (OR) 1.11, 95% confidence interval (CI) 1.02-1.21, P = 0.02] and absence of use of myorelaxant drugs at intubation (OR 0.13, 95% CI 0.01-0.99, P = 0.05). Eighteen patients presented a PES. Lesions associated with PES were edema (67%, P < 0.01) and abnormal VC mobility (67%, P < 0.01). These injuries were associated with duration of intubation (OR 1.05, 95% CI 1.01-1.09, P = 0.04), emergency intubation (OR 2.7, 95% CI 1.2-6.4, P = 0.02), and height/endotracheal tube size ratio (OR 0.97, 95% CI 0.95-0.99, P = 0.01). Seventeen patients were reintubated within 48 h following extubation. Laryngeal examination of these patients more frequently showed granulation (29.4%, P = 0.02) and abnormal VC mobility (58.8%, P < 0.01).


CONCLUSIONS
This study found a high frequency of laryngeal injuries after extubation in ICU, which were associated with intubation duration and patient's height/ETT size ratio. Edema was not the only injury responsible for PES, and although edema is frequent it is not the only injury associated with reintubation.
Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20-40, rue Leblanc, 75908, Paris Cedex 15, France. jean-marc.tadie@egp.aphp.fr
Jean-Marc
JM
Tadié
Eva
E
Behm
Lucien
L
Lecuyer
Rania
R
Benhmamed
Stéphane
S
Hans
Daniel
D
Brasnu
Jean-Luc
JL
Diehl
Jean-Yves
JY
Fagon
Emmanuel
E
Guérot
D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal / Q000009:adverse effects*; D019723:Endoscopes; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007830:Larynx / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors