Incidence Of Laryngeal Injury Research Articles

Effect of COVID-19 on the incidence of postintubation laryngeal lesions

Background Critically ill patients intubated in the intensive care unit experience prolonged intubation leading to increased frequency of laryngeal injuries. This study aimed to demonstrate a suspected increase in vocal fold injury in patients who were intubated with COVID-19 as compared with patients intubated for other reasons. Methods A retrospective review of medical records was performed to identify patients examined using flexible endoscopic evaluation of swallowing exams. The study included 25 patients with COVID-19 and 27 without COVID-19 at Baylor Scott & White Medical Center in Temple, Texas. Various injuries were evaluated, ranging from granulation tissue to vocal cord paralysis. Severe lesions were those causing clinically significant airway obstruction or requiring operative intervention. The incidence of laryngeal injury in patients intubated for COVID-19 was then compared with that of patients intubated for other reasons. Results The increased presence of severe injury in COVID-positive patients appeared clinically significant but was not statistically significant (P = 0.06). Interestingly, patients who received pronation therapy had 4.6 times the odds of more severe injury compared with patients who did not (P = 0.009). Conclusion Lower thresholds for performing flexible laryngoscopy on postintubated patients who are proned may allow for earlier intervention and reduce morbidity in an already at-risk population.

Morphometric Study on the Anatomy of the Fetal Cricoid Cartilage and Comparison between its Inner Diameter and Endotracheal Tube Sizes

The high incidence of respiratory disorders is one of the main problems in perinatal medical care. With the increased use of intubation, the incidence of laryngeal injury causing stenosis has also increased. The principal constriction point in the infant's larynx is the midcricoid area. We sought to provide detailed morphometric data on the anatomy of the cricoid cartilage and its relationship with growth and body characteristics of fetuses at 5 to 9 months of gestational age. Nineteen larynges obtained from 17 stillborn infants and 2 newborn infants ranging in gestational age from 5 to 9 months were studied. Measurements of the cricoid cartilage were made with a millimeter-graded caliper. Weight was the variable most correlated with cricoid measurements. The cricoid lumen configuration showed an almost elliptic shape and did not change with gestational age. The mean inner subglottic cricoid area was 19.27 +/- 9.62 mm2 and was related to weight and body surface area. Cricoid growth was more pronounced at the outer portion of the cartilage. The cricoid lumen configuration was elliptic, and its mean area was smaller than that of available endotracheal tubes. This lumen area was most influenced by weight and height.

Endoscopic diagnosis of laryngeal injury following endotracheal intubation

SummaryLaryngeal injury following endotracheal intubation occurs in many patients and intensive care physicians may remain unaware of the incidence of complications. This study evaluated the incidence of laryngeal injury in a group of patients who had intubation for > 4 days in an intensive care unit. In 14 patients, laryngeal injuries were evaluated by flexible and/or rigid endoscopes as soon as the patients were extubated or decannulated. In 64% of the patients, pathological signs, including ulceration, oedema, granulation and fibrosis, were determined by endoscopic examination. Postintubation injuries were very common. Endoscopic examination may be one of the best ways to diagnose these lesions because it allows early diagnosis and can be performed at the patients' bedside.