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Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study

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Abstract

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.

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Authors and Affiliations

  1. Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20-40, rue Leblanc, 75908, Paris Cedex 15, France

    Jean-Marc Tadié, Jean-Luc Diehl, Jean-Yves Fagon & Emmanuel Guérot

  2. Service d’ORL et de chirurgie de la face et du cou, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France

    Eva Behm, Rania Benhmamed, Stéphane Hans & Daniel Brasnu

  3. Service de Chirurgie Cardio-Vasculaire, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France

    Lucien Lecuyer

  4. Faculté de Médecine, Université Paris Descartes, Paris, France

    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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  1. Jean-Marc Tadié
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  2. Eva Behm
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Correspondence to Jean-Marc Tadié.

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Tadié, JM., Behm, E., Lecuyer, L. et al. Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study. Intensive Care Med 36, 991–998 (2010). https://doi.org/10.1007/s00134-010-1847-z

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  • DOI: https://doi.org/10.1007/s00134-010-1847-z

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