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....
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| Veröffentlicht in: | Intensive care medicine 2010-06, Vol.36 (6), p.991-998 |
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| creator | Tadié, Jean-Marc Behm, Eva Lecuyer, Lucien Benhmamed, Rania Hans, Stéphane Brasnu, Daniel Diehl, Jean-Luc Fagon, Jean-Yves Guérot, Emmanuel |
| description | 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
|
| doi_str_mv | 10.1007/s00134-010-1847-z |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_744614151</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A724333527</galeid><sourcerecordid>A724333527</sourcerecordid><originalsourceid>FETCH-LOGICAL-c573t-2fd849051f47817b454fd7d5f9c7a0f5db117cd09c87e5619ad42791c032b1bb3</originalsourceid><addsrcrecordid>eNqFkk1rFTEUhoMo9lr9AW5k0EVXqTn5mMy4K8VaoaALBXchk49LLnOTazIDbX99c5naYrkiWZzk5HlfOMmL0Fsgp0CI_FgIAcYxAYKh4xLfPkMr4IxioKx7jlaEcYp5y-kRelXKptKyFfASHVFCmZSiW6Ff31OZcIjTPOgppNiMOt_EtdNjE-JmzsGVRkfbuOsHwuswztl9anTjw-By2k3BNC7aVEza1W2ZZnvzGr3weizuzX09Rj8vPv84v8RX3758PT-7wkZINmHqbcd7IsBz2YEcuODeSit8b6QmXtgBQBpLetNJJ1roteVU9mAIowMMAztGJ4vvLqffsyuT2oZi3Djq6NJclOS8BQ4C_k8y1gtGYE--f0Ju0pxjHUNRaCntgJIKfVigtR6dCtGnKWuzt1RnknLGmKCyUvgAtXbRZT2m6Hyo7b_40wN8XdZtgzkogEVgciolO692OWzrJyogap8StaREkf25pkTdVs27-_nmYevsg-JPLCpAF6DUq5qG_PgA_3a9A39DxbM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>216228120</pqid></control><display><type>article</type><title>Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Tadié, Jean-Marc ; Behm, Eva ; Lecuyer, Lucien ; Benhmamed, Rania ; Hans, Stéphane ; Brasnu, Daniel ; Diehl, Jean-Luc ; Fagon, Jean-Yves ; Guérot, Emmanuel</creator><creatorcontrib>Tadié, Jean-Marc ; Behm, Eva ; Lecuyer, Lucien ; Benhmamed, Rania ; Hans, Stéphane ; Brasnu, Daniel ; Diehl, Jean-Luc ; Fagon, Jean-Yves ; Guérot, Emmanuel</creatorcontrib><description>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.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-010-1847-z</identifier><identifier>PMID: 20237758</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Aged ; Aged, 80 and over ; Anesthesiology ; Critical Care Medicine ; Device Removal - adverse effects ; Edema ; Emergency Medicine ; Endoscopes ; Endoscopy ; Equipment and supplies ; Extubation ; Female ; Fiber optics ; France ; Humans ; Injuries ; Intensive ; Intensive care ; Intensive Care Units ; Intubation ; Intubation, Intratracheal - adverse effects ; Larynx ; Larynx - injuries ; Male ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Middle Aged ; Original ; Pain Medicine ; Pediatrics ; Pneumology/Respiratory System ; Prospective Studies ; Risk Factors ; Suctioning ; Venture capital ; Weaning</subject><ispartof>Intensive care medicine, 2010-06, Vol.36 (6), p.991-998</ispartof><rights>Copyright jointly held by Springer and ESICM 2010</rights><rights>COPYRIGHT 2010 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c573t-2fd849051f47817b454fd7d5f9c7a0f5db117cd09c87e5619ad42791c032b1bb3</citedby><cites>FETCH-LOGICAL-c573t-2fd849051f47817b454fd7d5f9c7a0f5db117cd09c87e5619ad42791c032b1bb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-010-1847-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-010-1847-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,778,782,27911,27912,41475,42544,51306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20237758$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tadié, Jean-Marc</creatorcontrib><creatorcontrib>Behm, Eva</creatorcontrib><creatorcontrib>Lecuyer, Lucien</creatorcontrib><creatorcontrib>Benhmamed, Rania</creatorcontrib><creatorcontrib>Hans, Stéphane</creatorcontrib><creatorcontrib>Brasnu, Daniel</creatorcontrib><creatorcontrib>Diehl, Jean-Luc</creatorcontrib><creatorcontrib>Fagon, Jean-Yves</creatorcontrib><creatorcontrib>Guérot, Emmanuel</creatorcontrib><title>Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesiology</subject><subject>Critical Care Medicine</subject><subject>Device Removal - adverse effects</subject><subject>Edema</subject><subject>Emergency Medicine</subject><subject>Endoscopes</subject><subject>Endoscopy</subject><subject>Equipment and supplies</subject><subject>Extubation</subject><subject>Female</subject><subject>Fiber optics</subject><subject>France</subject><subject>Humans</subject><subject>Injuries</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Intubation</subject><subject>Intubation, Intratracheal - adverse effects</subject><subject>Larynx</subject><subject>Larynx - injuries</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Pain Medicine</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Suctioning</subject><subject>Venture capital</subject><subject>Weaning</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkk1rFTEUhoMo9lr9AW5k0EVXqTn5mMy4K8VaoaALBXchk49LLnOTazIDbX99c5naYrkiWZzk5HlfOMmL0Fsgp0CI_FgIAcYxAYKh4xLfPkMr4IxioKx7jlaEcYp5y-kRelXKptKyFfASHVFCmZSiW6Ff31OZcIjTPOgppNiMOt_EtdNjE-JmzsGVRkfbuOsHwuswztl9anTjw-By2k3BNC7aVEza1W2ZZnvzGr3weizuzX09Rj8vPv84v8RX3758PT-7wkZINmHqbcd7IsBz2YEcuODeSit8b6QmXtgBQBpLetNJJ1roteVU9mAIowMMAztGJ4vvLqffsyuT2oZi3Djq6NJclOS8BQ4C_k8y1gtGYE--f0Ju0pxjHUNRaCntgJIKfVigtR6dCtGnKWuzt1RnknLGmKCyUvgAtXbRZT2m6Hyo7b_40wN8XdZtgzkogEVgciolO692OWzrJyogap8StaREkf25pkTdVs27-_nmYevsg-JPLCpAF6DUq5qG_PgA_3a9A39DxbM</recordid><startdate>20100601</startdate><enddate>20100601</enddate><creator>Tadié, Jean-Marc</creator><creator>Behm, Eva</creator><creator>Lecuyer, Lucien</creator><creator>Benhmamed, Rania</creator><creator>Hans, Stéphane</creator><creator>Brasnu, Daniel</creator><creator>Diehl, Jean-Luc</creator><creator>Fagon, Jean-Yves</creator><creator>Guérot, Emmanuel</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</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>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7T2</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope></search><sort><creationdate>20100601</creationdate><title>Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study</title><author>Tadié, Jean-Marc ; Behm, Eva ; Lecuyer, Lucien ; Benhmamed, Rania ; Hans, Stéphane ; Brasnu, Daniel ; Diehl, Jean-Luc ; Fagon, Jean-Yves ; Guérot, Emmanuel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c573t-2fd849051f47817b454fd7d5f9c7a0f5db117cd09c87e5619ad42791c032b1bb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesiology</topic><topic>Critical Care Medicine</topic><topic>Device Removal - adverse effects</topic><topic>Edema</topic><topic>Emergency Medicine</topic><topic>Endoscopes</topic><topic>Endoscopy</topic><topic>Equipment and supplies</topic><topic>Extubation</topic><topic>Female</topic><topic>Fiber optics</topic><topic>France</topic><topic>Humans</topic><topic>Injuries</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>Intubation</topic><topic>Intubation, Intratracheal - adverse effects</topic><topic>Larynx</topic><topic>Larynx - injuries</topic><topic>Male</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Pain Medicine</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Suctioning</topic><topic>Venture capital</topic><topic>Weaning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tadié, Jean-Marc</creatorcontrib><creatorcontrib>Behm, Eva</creatorcontrib><creatorcontrib>Lecuyer, Lucien</creatorcontrib><creatorcontrib>Benhmamed, Rania</creatorcontrib><creatorcontrib>Hans, Stéphane</creatorcontrib><creatorcontrib>Brasnu, Daniel</creatorcontrib><creatorcontrib>Diehl, Jean-Luc</creatorcontrib><creatorcontrib>Fagon, Jean-Yves</creatorcontrib><creatorcontrib>Guérot, Emmanuel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tadié, Jean-Marc</au><au>Behm, Eva</au><au>Lecuyer, Lucien</au><au>Benhmamed, Rania</au><au>Hans, Stéphane</au><au>Brasnu, Daniel</au><au>Diehl, Jean-Luc</au><au>Fagon, Jean-Yves</au><au>Guérot, Emmanuel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2010-06-01</date><risdate>2010</risdate><volume>36</volume><issue>6</issue><spage>991</spage><epage>998</epage><pages>991-998</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>20237758</pmid><doi>10.1007/s00134-010-1847-z</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0342-4642 |
| ispartof | Intensive care medicine, 2010-06, Vol.36 (6), p.991-998 |
| issn | 0342-4642 1432-1238 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_744614151 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Aged Aged, 80 and over Anesthesiology Critical Care Medicine Device Removal - adverse effects Edema Emergency Medicine Endoscopes Endoscopy Equipment and supplies Extubation Female Fiber optics France Humans Injuries Intensive Intensive care Intensive Care Units Intubation Intubation, Intratracheal - adverse effects Larynx Larynx - injuries Male Medical research Medicine Medicine & Public Health Medicine, Experimental Middle Aged Original Pain Medicine Pediatrics Pneumology/Respiratory System Prospective Studies Risk Factors Suctioning Venture capital Weaning |
| title | Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study |
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