Document Detail

Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study.
MedLine Citation:
PMID:  20237758     Owner:  NLM     Status:  MEDLINE    
PURPOSE: 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). CONCLUSION: 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.
Jean-Marc Tadié; Eva Behm; Lucien Lecuyer; Rania Benhmamed; Stéphane Hans; Daniel Brasnu; Jean-Luc Diehl; Jean-Yves Fagon; Emmanuel Guérot
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Publication Detail:
Type:  Journal Article     Date:  2010-03-18
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-06     Completed Date:  2010-09-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  991-8     Citation Subset:  IM    
Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20-40, rue Leblanc, 75908, Paris Cedex 15, France.
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MeSH Terms
Aged, 80 and over
Device Removal / adverse effects*
Intensive Care Units
Intubation, Intratracheal / adverse effects*
Larynx / injuries*
Middle Aged
Prospective Studies
Risk Factors

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