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

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