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.
Tadié
Jean-Marc
JM
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
Behm
Eva
E
Lecuyer
Lucien
L
Benhmamed
Rania
R
Hans
Stéphane
S
Brasnu
Daniel
D
Diehl
Jean-Luc
JL
Fagon
Jean-Yves
JY
Guérot
Emmanuel
E
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