Unilateral Vocal Fold Immobility After Prolonged Endotracheal Intubation

Campbell, Benjamin R.; Shinn, Justin R.; Kimura, Kyle S.; Lowery, Anne S.; Casey, Jonathan D; Ely, E. Wesley; Gelbard, Alexander

doi:10.1001/jamaoto.2019.3969

Cited by 17 publications

(16 citation statements)

References 49 publications

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“…Prone positioning was a factor that was significantly different between the two groups. It has been suggested that UVFI after endotracheal intubation is caused by recurrent laryngeal nerve paralysis (RLNP) due to compressive neural injury or arytenoid dislocation/subluxation 14,20,21 . It was difficult to differentiate between these two diseases because we did not perform laryngeal electromyography.…”

Section: Discussionmentioning

confidence: 96%

“…Our results, which demonstrated UVFI in approximately 30% of patients, were consistent with these previous reports. The reported incidence of UVFI after prolonged intubation ranges from 7% to 41% among patients without COVID‐19 14–17 . However, it has not previously been reported whether there is a difference in the frequency of UVFI between COVID‐19 and other diseases requiring endotracheal intubation.…”

Section: Discussionmentioning

confidence: 99%

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Laryngeal complications after endotracheal intubation and prone positioning in patients with coronavirus disease 2019

Aibara

Okada

Tanaka-Nishikubo

et al. 2022

Laryngoscope Investig Oto

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Objectives: Laryngeal complications have been reported after endotracheal intubation and prone positioning in patients with critical coronavirus disease 2019 (COVID-19), but their association is unclear. In this study, we investigated the rate of laryngeal complications in patients with COVID-19 compared to an alternative condition (control group). Methods:We retrospectively analyzed the data of 40 patients who underwent endotracheal intubation for either COVID-19 or an alternative condition (control group).Data on age, sex, body mass index (BMI), cardiovascular disease (CVD) risk factors, use of prone therapy, duration of endotracheal intubation, and duration from extubation/tracheostomy to laryngeal evaluation were collected from medical records.Results: There were no significant differences in BMI, frequency of CVD risk factors, duration of endotracheal intubation, or duration from extubation/tracheostomy to laryngeal evaluation between the two groups. In the COVID-19 group, all patients adopted the prone position. In comparison, only one patient in the control group adopted the prone position. Significant differences were observed between the two groups regarding the incidence of vocal fold immobility and laryngeal granuloma. Conclusion:Laryngeal complications were more common in the COVID-19 group than in the control group. Prone positioning may be a risk factor for these complications.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Laryngeal complications after endotracheal intubation and prone positioning in patients with coronavirus disease 2019

Aibara

Okada

Tanaka-Nishikubo

et al. 2022

Laryngoscope Investig Oto

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“…The postoperative laryngeal complications could be a result of direct or indirect trauma to the vocal cords causing edema, hematoma, or nerve stretch 18 . For the first time, our study provided significant direct objective evidence, that intubation will lead to laryngeal inflammation, which decreased the glottic area and vocal angle and increased the vocal fold width and area.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Measurement of Adult Human Larynx post General Anesthesia with Intubation

Kuo¹,

Barman²,

Liu³

2022

Int. J. Med. Sci.

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Introduction:Post-anaesthetic sore throat (PAST) is a well-recognized consequence of tracheal intubation; however, quantitative morphometric measurements remain challenging. This study aimed to introduce a special laser projection device that can facilitate computer-assisted, digitalized analysis and provide important information on laryngeal mucosa change, pre and post-surgery under general anesthesia with intubation. Materials and methods: The laryngeal images were captured and divided into the control group and the intubation group. Image processing techniques were used to quantify the post-extubation laryngeal variation, with its distinct color space and texture features. Meanwhile, the maximum length of the vocal fold, vocal width at the midpoint, and maximum cross-sectional area of the glottic space were determined and calculated. These parameters were analyzed and compared pre and post-surgery. Results: A total of 69 subjects were enrolled in this study, comprising 32 subjects in the healthy group and 37 subjects in the intubation group. The color space and texture analysis with contrast and correlation profiles all shows trend toward higher measures in the intubation group than in the healthy group, with statistical significance and outstanding discrimination ability, especially in the interarytenoid region. The incidence of PAST was approximately 46% (17 patients). The gender difference, type of surgery, and the fixation position of the tube were not significantly related to the PAST occurrence. All the eigenvalues showed significant differences pre and post-surgery in the interarytenoid region and a significant trend toward red and increased contrast texture profiles was revealed. Furthermore, the glottic area showed a significant decrease of 25.29%, while the vocal width showed a significant increase post extubation. Conclusion: Our equipment and processing can measure subtle laryngeal changes that would allow a clinician to diagnose postoperative laryngeal inflammation in a simpler and less invasive way. The trend toward red, the increased contrast texture and vocal width, and the reduced glottic space were all compatible with post-intubation inflammatory response, especially in the interarytenoid region. This is important to know so that one can take appropriate steps to alleviate PAST in the future.

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“…Trauma during endotracheal intubation could cause post-operative laryngeal complications with vocal cords edema or hematoma ( 13 ). Inflammation changes the tissue composition leading to higher water content and edema leads to significant changes in laryngeal mucosal thickness, including decreases the glottic area and vocal angle and increases the vocal fold width and area.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Measurement of Throat and Larynx After Endotracheal Intubation for Palatoplasty

2022

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IntroductionQuantitative morphometric measurements of living human upper airway remain challenging. This study aimed to introduce a special laser projection device that can facilitate computer-assisted, digitalized analysis and provide important information on airway mucosa change, before and after endotracheal intubation for palatoplasty.Materials and MethodsThe laryngeal images were captured before and after surgery. Image processing techniques were used to quantize the post-operative laryngeal variation, with its distinct color space and texture features. Meanwhile, the maximum length of the vocal fold, vocal width at the midpoint, maximum cross-sectional area of the glottic space, maximum cross-sectional area of the oropharyngeal inlet (CSAOI) and the depth of the retropalatal space were determined and calculated. These parameters were analyzed and compared before and after surgery.ResultsA total of 39 subjects were enrolled in this study. The color space and texture analysis all show trends toward higher measures in post-operative images than in pre-operative images, especially in the interarytenoid region. Furthermore, the glottic area showed a significant decrease of 31.2%, while the vocal width showed a significant increase after intubation. The post-operative retropalatal depth and CSAOI were significantly deeper and larger than the baseline, reaching their peak in the 4th week after the surgery, and then slightly reduced in the 12th week.ConclusionFor the first time we present a series of changes in upper airway after surgery, by using a laser module with quantitative measurement. Our equipment and processing can measure subtle mucosal changes that would allow a clinician to diagnose post-operative airway inflammation in a simpler and less invasive way. Here additional information collected by different imaging modalities would help to solve multiple current unmet needs in post-operative airway inflammation.

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Unilateral Vocal Fold Immobility After Prolonged Endotracheal Intubation

Cited by 17 publications

References 49 publications

Laryngeal complications after endotracheal intubation and prone positioning in patients with coronavirus disease 2019

Laryngeal complications after endotracheal intubation and prone positioning in patients with coronavirus disease 2019

Quantitative Measurement of Adult Human Larynx post General Anesthesia with Intubation

Quantitative Measurement of Throat and Larynx After Endotracheal Intubation for Palatoplasty

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