Classification of laryngeal injury in patients with prolonged intubation and to determine the factors that cause the injury

Classification of laryngeal injury in patients with prolonged intubation and to determine the factors that cause the injury:



Publication date: Available online 17 February 2020

Source: American Journal of Otolaryngology

Author(s): Dursun Mehmet Mehel, Doğukan Özdemir, Mehmet Çelebi, Samet Aydemir, Gökhan Akgül, Abdulkadir Özgür

Abstract

Objective

This study aims to evaluate injuries occurring in the larynx of patients intubated in intensive care units for a long time.

Study design

Prospective clinical study.

Setting

Tertiary hospital.

Subject and methods

Between April 15, 2019, and November 15, 2019, 40 patients who were hospitalized in intensive care units had a tracheotomy procedure due to prolonged intubation, and laryngeal structures were evaluated by direct laryngoscopy. The laryngeal structures were evaluated in four groups as glottic-supraglottic region, arytenoid vocal process, interaritenoid region and subglottic region. Edema, granulation and ulceration findings in these four regions were recorded. The injuries to the laryngeal structures were classified as stages 0–3. As a result of the data obtained, the relationship between the degree of laryngeal lesions and the factors that may cause these lesions was investigated.

Results

According to our classification, nine patients had stage 1, 16 patients had stage 2 and 15 patients had stage 3 laryngeal injury. There was no significant relationship between the stage of laryngeal injury and age, sex and diameter of the intubation tube. There was a statistically significant relationship between laryngeal injury and the day the tracheotomy was performed (p = 0.007).

Conclusion

In patients that had prolonged endotracheal intubation, injury to the laryngeal structures is inevitable. To minimize this occurrence, tracheotomy should be performed for intubations that extend for more than seven days. When performing the tracheotomy, the laryngeal structures should be evaluated, necessary precautions should be taken for the traumatic lesions that are difficult to heal, and treatment should be started.