PROLONGED ENDOTRACHEAL INTUBATION

Abstract

SESSION TITLE: Imaging SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: Laryngeal injury following intubation is a well described complication and ranges from uncomplicated edema to subglottic stenosis with a trend toward more harm with increasing duration.The accepted time limit of an indwelling ETT at our hospital is 14 days after which tracheostomy is pursued if continued airway support is needed.This case report illustrates the findings in a patient with oral endotracheal intubation for 145 days, a duration that to our knowledge has not been reported in the past. CASE PRESENTATION: A 39-year old male was transferred from an outside hospital for neurosurgical evaluation after being found down with initial head CT showing extensive IVH presumed to be from tumor hemorrhage. The patient has a history of third ventricle and suprasellar ganglioglioma since age 16 with multiple prior surgeries and shunt placements requiring frequent tappings for symptomatic hydrocephalus. Initial GCS was 3 and he was intubated prior to arrival at our hospital for airway protection.He had an extended hospital stay due to the expected severe neurologic sequelae of the insult that was compounded by the family's lingering resistance toward any surgical intervention including tracheostomy, which led to the almost 5-month long intubation. After consent was eventually granted, the patient underwent direct microlaryngoscopy that showed no significant mucosal damage but revealed severe erosion of the posterior laryngeal commissure and post-cricoid area. He underwent successful tracheostomy with planned repeat laryngoscopy for possible steroid injection or mitomycin treatment to attempt to prevent cicatricial stenosis. DISCUSSION: The circumstances of intubation, patient comorbidities and the mechanical presence of a foreign object within the delicate structures of the larynx all contribute to the development of laryngeal injury. The majority of complications are minor enough to resolve on their own and although this case represents an extreme example, it demonstrates the significant and irreversible damage that can occur to laryngeal structures with long-term presence of an endotracheal tube CONCLUSIONS: In summary, this case demonstrates one of the possible consequences of an excessively prolonged intubation. Our hypothesis prior to visualization was that the vocal cords and ETT could have possible adhered to each other making removal impossible without dissection. However this posterior erosion one can wonder how long this could have persisted before encroaching on the esophagus. Reference #1: Long-term complications of artificial airways. Richard D Sue MD, Irawan Susanto MD, FACP. Clin Chest Med 24 (2003) 457-471 DISCLOSURES: No relevant relationships by Andrea Fekete, source=Web Response