Outcomes of Intubation-induced Vocal Fold Motion Impairment
Vocal fold motion impairment (VFMI) is a potential consequence of intubation. Studies describing the natural course of this complication are largely case reports. This study aims to evaluate outcomes for a cohort of patients who endured varying degrees of vocal fold immobility or hypomobility post-i...
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Veröffentlicht in: | Journal of voice 2020-03, Vol.34 (2), p.250-258 |
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description | Vocal fold motion impairment (VFMI) is a potential consequence of intubation. Studies describing the natural course of this complication are largely case reports. This study aims to evaluate outcomes for a cohort of patients who endured varying degrees of vocal fold immobility or hypomobility post-intubation.
Retrospective chart review.
Upon excluding known causes of VFMI, such as surgeries and tumors involving the head and neck, VFMI cases (ICD-9 diagnosis code 478.3) were identified from 2008 to 2014 at a regional healthcare institution. A total of 2,387 were identified and of those, 25 were intubation-induced VFMI cases. This cohort was then examined for notable features.
With a mean prolonged intubation duration of 6.55 days, 68% of cases resulted in left unilateral, 8% right unilateral, and 24% bilateral VFMI. Overall, 80% of patients experienced a recovery outcome (voice improvement or restoration of vocal fold mobility). Median recovery time was 4.31 months (mean, 6.51 months; range, 19-715 days). In cases of unilateral VFMI, 95% of cases had a recovery outcome. In cases of bilateral VFMI, 33% of cases had a recovery outcome. Additionally, bilateral cases showed a statistically significant association with an approximately 36-fold lower odds of recovery than unilateral cases (odds ratio, 0.0278; 95% confidence interval, 0.0020-0.3868; P value, 0.0077).
Intubation-induced VFMI is rare. In this cohort, most cases resulted from prolonged intubation. While spontaneous recovery was the most common outcome, full remission was not guaranteed in every case. A sizable proportion of cases revealed bilateral motion impairment which was less likely to resolve. Our results are informative for tracheostomy decision-making and differential diagnoses for post-intubation laryngeal symptomatology. |
doi_str_mv | 10.1016/j.jvoice.2018.09.015 |
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Retrospective chart review.
Upon excluding known causes of VFMI, such as surgeries and tumors involving the head and neck, VFMI cases (ICD-9 diagnosis code 478.3) were identified from 2008 to 2014 at a regional healthcare institution. A total of 2,387 were identified and of those, 25 were intubation-induced VFMI cases. This cohort was then examined for notable features.
With a mean prolonged intubation duration of 6.55 days, 68% of cases resulted in left unilateral, 8% right unilateral, and 24% bilateral VFMI. Overall, 80% of patients experienced a recovery outcome (voice improvement or restoration of vocal fold mobility). Median recovery time was 4.31 months (mean, 6.51 months; range, 19-715 days). In cases of unilateral VFMI, 95% of cases had a recovery outcome. In cases of bilateral VFMI, 33% of cases had a recovery outcome. Additionally, bilateral cases showed a statistically significant association with an approximately 36-fold lower odds of recovery than unilateral cases (odds ratio, 0.0278; 95% confidence interval, 0.0020-0.3868; P value, 0.0077).
Intubation-induced VFMI is rare. In this cohort, most cases resulted from prolonged intubation. While spontaneous recovery was the most common outcome, full remission was not guaranteed in every case. A sizable proportion of cases revealed bilateral motion impairment which was less likely to resolve. Our results are informative for tracheostomy decision-making and differential diagnoses for post-intubation laryngeal symptomatology.</description><identifier>ISSN: 0892-1997</identifier><identifier>EISSN: 1873-4588</identifier><identifier>DOI: 10.1016/j.jvoice.2018.09.015</identifier><identifier>PMID: 30309770</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biomechanical Phenomena ; Dysphonia - diagnosis ; Dysphonia - etiology ; Dysphonia - physiopathology ; Female ; Humans ; Intubation, Intratracheal - adverse effects ; Larynx ; Male ; Middle Aged ; Outcomes ; Prognosis ; Prolonged intubation ; Recovery of Function ; Retrospective Studies ; Risk Factors ; Time Factors ; Vocal Cord Paralysis - diagnosis ; Vocal Cord Paralysis - etiology ; Vocal Cord Paralysis - physiopathology ; Vocal Cords - physiopathology ; Vocal fold wound healing ; Voice Quality ; Voice/dysphonia</subject><ispartof>Journal of voice, 2020-03, Vol.34 (2), p.250-258</ispartof><rights>2018</rights><rights>Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-9d41e53851aa6b8d2966d5e2f80732045004b86616fa94480c2aba44b29b0ebb3</citedby><cites>FETCH-LOGICAL-c362t-9d41e53851aa6b8d2966d5e2f80732045004b86616fa94480c2aba44b29b0ebb3</cites><orcidid>0000-0002-9422-0340</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvoice.2018.09.015$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30309770$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pan, Debbie R.</creatorcontrib><creatorcontrib>Jiang, Nancy</creatorcontrib><title>Outcomes of Intubation-induced Vocal Fold Motion Impairment</title><title>Journal of voice</title><addtitle>J Voice</addtitle><description>Vocal fold motion impairment (VFMI) is a potential consequence of intubation. Studies describing the natural course of this complication are largely case reports. This study aims to evaluate outcomes for a cohort of patients who endured varying degrees of vocal fold immobility or hypomobility post-intubation.
Retrospective chart review.
Upon excluding known causes of VFMI, such as surgeries and tumors involving the head and neck, VFMI cases (ICD-9 diagnosis code 478.3) were identified from 2008 to 2014 at a regional healthcare institution. A total of 2,387 were identified and of those, 25 were intubation-induced VFMI cases. This cohort was then examined for notable features.
With a mean prolonged intubation duration of 6.55 days, 68% of cases resulted in left unilateral, 8% right unilateral, and 24% bilateral VFMI. Overall, 80% of patients experienced a recovery outcome (voice improvement or restoration of vocal fold mobility). Median recovery time was 4.31 months (mean, 6.51 months; range, 19-715 days). In cases of unilateral VFMI, 95% of cases had a recovery outcome. In cases of bilateral VFMI, 33% of cases had a recovery outcome. Additionally, bilateral cases showed a statistically significant association with an approximately 36-fold lower odds of recovery than unilateral cases (odds ratio, 0.0278; 95% confidence interval, 0.0020-0.3868; P value, 0.0077).
Intubation-induced VFMI is rare. In this cohort, most cases resulted from prolonged intubation. While spontaneous recovery was the most common outcome, full remission was not guaranteed in every case. A sizable proportion of cases revealed bilateral motion impairment which was less likely to resolve. Our results are informative for tracheostomy decision-making and differential diagnoses for post-intubation laryngeal symptomatology.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomechanical Phenomena</subject><subject>Dysphonia - diagnosis</subject><subject>Dysphonia - etiology</subject><subject>Dysphonia - physiopathology</subject><subject>Female</subject><subject>Humans</subject><subject>Intubation, Intratracheal - adverse effects</subject><subject>Larynx</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Outcomes</subject><subject>Prognosis</subject><subject>Prolonged intubation</subject><subject>Recovery of Function</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Vocal Cord Paralysis - diagnosis</subject><subject>Vocal Cord Paralysis - etiology</subject><subject>Vocal Cord Paralysis - physiopathology</subject><subject>Vocal Cords - physiopathology</subject><subject>Vocal fold wound healing</subject><subject>Voice Quality</subject><subject>Voice/dysphonia</subject><issn>0892-1997</issn><issn>1873-4588</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9LxDAUxIMo7vrnG4j06KX1JU3TBEEQcXVB8aJeQ5K-Qpa2WZtW8NvbpatHT-8wM2-YHyEXFDIKVFxvss1X8A4zBlRmoDKgxQFZUlnmKS-kPCRLkIqlVKlyQU5i3AAAm9RjssghB1WWsCQ3r-PgQosxCXWy7obRmsGHLvVdNTqsko_gTJOsQlMlL2GnJOt2a3zfYjeckaPaNBHP9_eUvK8e3u6f0ufXx_X93XPqcsGGVFWcYpHLghojrKyYEqIqkNUSypwBLwC4lUJQURvFuQTHjDWcW6YsoLX5Kbma_2778DliHHTro8OmMR2GMWpGp42sEBQmK5-trg8x9ljrbe9b039rCnqHTW_0jE3vsGlQesI2xS73DaNtsfoL_XKaDLezAaedXx57HZ3HbiLke3SDroL_v-EH-KF-tg</recordid><startdate>202003</startdate><enddate>202003</enddate><creator>Pan, Debbie R.</creator><creator>Jiang, Nancy</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9422-0340</orcidid></search><sort><creationdate>202003</creationdate><title>Outcomes of Intubation-induced Vocal Fold Motion Impairment</title><author>Pan, Debbie R. ; Jiang, Nancy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-9d41e53851aa6b8d2966d5e2f80732045004b86616fa94480c2aba44b29b0ebb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomechanical Phenomena</topic><topic>Dysphonia - diagnosis</topic><topic>Dysphonia - etiology</topic><topic>Dysphonia - physiopathology</topic><topic>Female</topic><topic>Humans</topic><topic>Intubation, Intratracheal - adverse effects</topic><topic>Larynx</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Outcomes</topic><topic>Prognosis</topic><topic>Prolonged intubation</topic><topic>Recovery of Function</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Vocal Cord Paralysis - diagnosis</topic><topic>Vocal Cord Paralysis - etiology</topic><topic>Vocal Cord Paralysis - physiopathology</topic><topic>Vocal Cords - physiopathology</topic><topic>Vocal fold wound healing</topic><topic>Voice Quality</topic><topic>Voice/dysphonia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pan, Debbie R.</creatorcontrib><creatorcontrib>Jiang, Nancy</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of voice</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pan, Debbie R.</au><au>Jiang, Nancy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Intubation-induced Vocal Fold Motion Impairment</atitle><jtitle>Journal of voice</jtitle><addtitle>J Voice</addtitle><date>2020-03</date><risdate>2020</risdate><volume>34</volume><issue>2</issue><spage>250</spage><epage>258</epage><pages>250-258</pages><issn>0892-1997</issn><eissn>1873-4588</eissn><abstract>Vocal fold motion impairment (VFMI) is a potential consequence of intubation. Studies describing the natural course of this complication are largely case reports. This study aims to evaluate outcomes for a cohort of patients who endured varying degrees of vocal fold immobility or hypomobility post-intubation.
Retrospective chart review.
Upon excluding known causes of VFMI, such as surgeries and tumors involving the head and neck, VFMI cases (ICD-9 diagnosis code 478.3) were identified from 2008 to 2014 at a regional healthcare institution. A total of 2,387 were identified and of those, 25 were intubation-induced VFMI cases. This cohort was then examined for notable features.
With a mean prolonged intubation duration of 6.55 days, 68% of cases resulted in left unilateral, 8% right unilateral, and 24% bilateral VFMI. Overall, 80% of patients experienced a recovery outcome (voice improvement or restoration of vocal fold mobility). Median recovery time was 4.31 months (mean, 6.51 months; range, 19-715 days). In cases of unilateral VFMI, 95% of cases had a recovery outcome. In cases of bilateral VFMI, 33% of cases had a recovery outcome. Additionally, bilateral cases showed a statistically significant association with an approximately 36-fold lower odds of recovery than unilateral cases (odds ratio, 0.0278; 95% confidence interval, 0.0020-0.3868; P value, 0.0077).
Intubation-induced VFMI is rare. In this cohort, most cases resulted from prolonged intubation. While spontaneous recovery was the most common outcome, full remission was not guaranteed in every case. A sizable proportion of cases revealed bilateral motion impairment which was less likely to resolve. Our results are informative for tracheostomy decision-making and differential diagnoses for post-intubation laryngeal symptomatology.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30309770</pmid><doi>10.1016/j.jvoice.2018.09.015</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-9422-0340</orcidid></addata></record> |
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subjects | Adolescent Adult Aged Aged, 80 and over Biomechanical Phenomena Dysphonia - diagnosis Dysphonia - etiology Dysphonia - physiopathology Female Humans Intubation, Intratracheal - adverse effects Larynx Male Middle Aged Outcomes Prognosis Prolonged intubation Recovery of Function Retrospective Studies Risk Factors Time Factors Vocal Cord Paralysis - diagnosis Vocal Cord Paralysis - etiology Vocal Cord Paralysis - physiopathology Vocal Cords - physiopathology Vocal fold wound healing Voice Quality Voice/dysphonia |
title | Outcomes of Intubation-induced Vocal Fold Motion Impairment |
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