Prolonged Intubation Injuries of the Larynx: Endoscopic Diagnosis, Classification, And Treatment

Abstract

Laryngeal trauma from prolonged endotracheal intubation occurs in patients of all ages. Most changes are superficial and heal quickly. Injuries that are found consistently during intubation include nonspecific changes, edema, granulation tissue, ulceration, and othermiscellaneous injuries. In thispapersignificant, severe, and lasting trauma of the larynx has been classified on thebasis of theknown factors in pathogenesis, observations made atendoscopy, and photographic documentation. This classification has required introduction of new descriptive terminology: "tongues of granulation tissue," "ulcerated troughs," "healed furrows," and "healed fibrous nodule." During intubation the degree of injury can be precisely assessed under general anesthesia by using telescopes for image magnification, thus assisting adecision whether to continue intubation orperform tracheotomy to minimize long-term morbidity. Changes that are found after extubation result from granulation tissue, ulceration, ora combination of both and have been illustrated on flow charts; a knowledge and understanding of these sequelae allows them to be identified by both indirect and direct laryngoscopy so that treatment can be planned.

Cricotracheal resection for adult subglottic stenosis: Factors predicting treatment failure

“…In the remainder of patients, the exact etiology is idiopathic in nature . The subglottis and the posterior glottis are the two most commonly involved sites …”

Proposing an Endotracheal Tube Selection Tool Based on Multivariate Analysis of Airway Imaging

“…The risk of the oversized ETT may include minor complications, such as nonobstructive edema, granulation tissue formation, simple ulcerations, and sore throat, while serious complications include excessive granulation tissue formation, obstructing edema, posterior glottic or subglottic stenosis, arytenoid dislocation, and vocal cord immobility. [10][11][12]27 An editorial published in 2012 recommended an ETT size 9.0 for men and 8.0 for women. 29 The application of this recommendation to our sample would inevitably result in laryngotracheal trauma in 20% of our patients who exhibited a proximal subglottic TD that was smaller than the OD of the ETT suggested.…”

“…[1][2][3][4][5][6][7][8] The different segments of the airway have been examined regarding size, factors predisposing to diameter changes, and factors leading to postintubation complications. 6,7,[9][10][11][12] Despite the extensive research on the airway anatomy, no strong conclusions emerge regarding the narrowest segment of the adult airway.…”

“…Glottic and subglottic stenoses, vocal cord immobility, and arytenoid dislocation are wellknown complications which eventually may need complex airway surgeries or temporary or even permanent tracheostomy tube. [10][11][12]27 By contrast, undersized ETTs may compromise ventilation and hinder pulmonary hygiene or fiberoptic bronchoscopy, particularly in intensive care settings. 28,29 The present study aims to measure the dimensions of multiple upper airway segments in adults to determine the narrowest segment in this population.…”

Benign Central Airway Obstruction

“…40,41 While endotracheal tube cuffs are usually low pressure and high volume, they nevertheless exert pressure on the larynx and trachea. 42 Endotracheal tube cuff pressures are particularly damaging to the trachea if they are overinflated, with pressures greater than 20 cm H 2 O causing ischemic injury, necrosis, granulation tissue formation, and subsequent stenosis. 43 PTTS occurs similarly due to trauma to the trachea (►Fig.…”