L aryngotracheal stenosis is a treatable cause of disability following mechanical ventilation in intensive care units (ICUs). Early diagnosis favourably modifies the natural history of the disease, 1 while diagnostic failure causes significant pulmonary morbidity and can progress to life-threatening airway compromise. Prevention and early recognition of post-ICU complications is an increasing focus of intensive care medicine and in this context, planning screening programmes for this condition through ICU follow-up clinics or as standalone programmes requires understanding of the incidence of post-intubation laryngotracheal stenosis. We undertook an exercise to estimate the incidence of this condition in the UK.The average number of admissions to all ICUs in the UK is 130,000 per annum. 2 It is not precisely known how many patients receive mechanical ventilation and for how long, but 34.2% of UK patients stay in ICU for more than two days and this patient group has a survival rate of 70.2%. 3 An international study of 15,757 patients estimated that 32.9% of ICU patients received mechanical ventilation for more than 12 hours, with a survival rate of 69.3%. 4 If we therefore assume that only 33% of UK ICU patients receive mechanical ventilation and that their survival rate is 70%, which gives an estimate of 30,030 annual survivors of mechanical ventilation and therefore represents an estimate of the at-risk population in the UK.The incidence of late post-intubation laryngotracheal stenosis (PILS) can be estimated from a prospective study of 654 consecutive intensive care patients undergoing mechanical ventilation, which identified 12 cases of severe glottic, subglottic or tracheal stenoses 6-12 months following extubation among the 389 survivors, which translates to an incidence of late PILS among survivors of mechanical ventilation of 3.1%. If lesser degrees of subglottic/tracheal stenosis are also considered, the incidence of late PILS rises to 4.6%. 5 Extrapolating this to the UK population of survivors of mechanical ventilation with these numbers gives an estimate of the incidence of severe late PILS of 926 new cases per year. Alarmingly, however, based on the number of annual patients undergoing laryngotracheal surgery, we have previously estimated the annual population incidence of patients treated to be 197, 6 which on the surface suggests that as many as four out of five patients with severe PILS do not receive treatment.We accept that there are significant limitations to the derivation of this number, due primarily to the unavailability of accurate UK data for the number of patients receiving mechanical ventilation in intensive care and the duration of this support. To our knowledge, there are currently no prospective cohort studies of the incidence of PILS from a UK sample of intensive care patients. In the absence of this information, the current calculation provides the best available estimate of the incidence of adult PILS. If confirmed, the fact that as many as four in five patients with severe postin...
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