title: Intubation-related tracheal ischemic lesions: incidence, risk factors, and outcome.
abstract: OBJECTIVE
  To determine incidence, risk factors and outcome of tracheal ischemic lesions related to intubation.
  
  
  METHODS
  Planned post hoc analysis using patients from a previous randomized controlled study. Fiberoptic tracheoscopy was performed during the 24 h following extubation. In patients with >2 ischemic lesions, ulcer or tracheal rupture, fiberoptic tracheoscopy was repeated 2 weeks after the last extubation. Tracheal ischemic lesions were predefined based on a quantitative score.
  
  
  RESULTS
  Ninety-six adult patients were included in this study. Eighty (83 %) patients had at least one tracheal ischemic lesion. Thirty-seven (38 %) patients had a tracheal ischemia score > median score (5; IQ 1, 7). The most common tracheal ischemic lesion was ischemia (68 %), followed by hyperemia (54 %), ulcer (10 %), and tracheal rupture (1 %). Univariate analysis identified duration of neuromuscular-blocking agent use, overinflation of tracheal cuff (>30 cmH2O), percentage of P cuff determination >30 cmH2O, duration of assist-control ventilation, and plateau pressure as risk factors for having a tracheal ischemia score >5. Duration of assist-control mechanical ventilation was the only factor independently associated with tracheal ischemia score >5 [OR (95 % CI) 1.10 per hour (1.02-1.20)]. A fiberoptic tracheoscopy was performed 2 weeks after extubation in 22 patients. This examination was normal in all patients, except the one with tracheal rupture who had marked improvement.
  
  
  CONCLUSIONS
  Tracheal ischemic lesions are common in intubated, critically ill patients. Duration of assist-control mechanical ventilation through a tracheal tube is the only independent risk factor. These lesions healed in the majority of patients 2 weeks after extubation.
authors.affiliation: Intensive Care Unit, Calmette Hospital, University Hospital of Lille, CHRU, Boulevard du Pr Leclercq, 59037, Lille cedex, France.
authors.forename: Lylia
authors.initials: L
authors.lastname: Touat
authors.forename: Clément
authors.initials: C
authors.lastname: Fournier
authors.forename: Philippe
authors.initials: P
authors.lastname: Ramon
authors.forename: Julia
authors.initials: J
authors.lastname: Salleron
authors.forename: Alain
authors.initials: A
authors.lastname: Durocher
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D004724:Endoscopy / Q000379:methods; D005260:Female; D005336:Fiber Optic Technology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D007511:Ischemia / Q000150:complications / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012720:Severity of Illness Index; D014133:Tracheal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome