title: Early laryngeal injury and complications because of endotracheal intubation in acutely poisoned patients: a prospective observational study.
abstract: OBJECTIVE
  Tracheal intubation may represent a life-saving supportive measure in many acutely poisoned patients. Although considered as a safe procedure, intubation may rapidly damage laryngeal mucosa. The incidence and nature of short-duration intubation-associated laryngeal injuries are unknown in the population of poisoned patients.
  
  
  METHODS
  We designed a prospective clinical investigation to study intubation-related laryngeal complications in poisonings. All consecutive intubated poisoned patients admitted over a 20-month period in our toxicological intensive care unit in a teaching hospital were included in this study. Daily clinical observation and laryngeal fiberscopic evaluation were performed to assess intubation-related laryngeal complications.
  
  
  RESULTS
  We included 266 consecutive poisoned patients who had been intubated [116M/150F; age 41 years (31-53); median (25-75% percentiles); simplified acute physiology score II 43 (32-51); intubation time 24 h (13-52)]. Intubation was mainly performed at the scene (69%) and depended on the level of coma (89%). Complications included postextubation laryngeal dyspnea (9%) requiring mandatory reintubation (2%). Laryngoscopy was performed in 209 patients (79%) within 24 h after extubation. Eighty percent of patients presented significant initial laryngeal lesions. Stepwise logistic regression showed that two variables were predictive of injuries: female gender (odds ratio: 2.6; 95% confidence interval: 1.3-5.3) and intubation time > or =72 h (odds ratio: 6.4; confidence interval: 1.5-27.6). Overall, injuries were independent of age, severity of illness, coma level, vital signs, intoxicants, and intubation modalities. The most severe injuries were significantly associated with intubation time (p < 0.001) and simplified acute physiology score II (p = 0.04). Within 24 h following extubation, persistent dysphonia (p < 0.0001), dysphagia (p < 0.0001), or pharyngeal pain (p = 0.02) were predictive of laryngeal injury.
  
  
  CONCLUSIONS
  Despite short-duration intubation, poisoned patients are at high risk of initial laryngeal injury.
authors.affiliation: Department of Toxicological and Medical Critical Care, Lariboisière Hospital, Paris-Diderot University, France. bruno-megarbane@wanadoo.fr <bruno-megarbane@wanadoo.fr>
authors.forename: Bruno
authors.initials: B
authors.lastname: Megarbane
authors.forename: Thu
authors.initials: T
authors.lastname: Be Hong
authors.forename: Romain
authors.initials: R
authors.lastname: Kania
authors.forename: Philippe
authors.initials: P
authors.lastname: Herman
authors.forename: Frédéric J
authors.initials: FJ
authors.lastname: Baud
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007818:Laryngeal Diseases / Q000453:epidemiology; D007830:Larynx / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D019370:Observation; D011041:Poisoning / Q000150:complications / Q000628:therapy*; D011446:Prospective Studies