RISK FACTORS ASSOCIATED WITH PROLONGED INTUBATION AND LARYNGEAL INJURY

A prospective study evaluated potential risk factors associated with l aryngeal injury after prolonged endotracheal tube intubation for longe r than 3 days. Ninety-seven patients were evaluated after oral endotra chael tube intubation (mean, 9 days). This study updates a previously reported evaluation of 44 patients. The additional sample size has pro vided findings of unreported patient risk factors of laryngeal injury and confirmation of previous associations. The majority of the 97 pati ents had some type of laryngeal injury, ranging from mild mucosal eryt hema to ulceration, granuloma formation, or true vocal cord immobility . Patient examinations were continued until the larynx returned to nor mal or stabilized or the patient was lost to follow-up. Postextubation examinations in the survival group revealed the following. (1) Laryng eal erythema occurred in 94%, and ulceration occurred in 76% of the pa tients with resolution within 6 weeks. (2) Laryngeal granulomas occurr ed in 44% of the patients; the majority of the granulomas (57%) develo ped an average of 4 weeks after extubation. Associated risk factors in cluded duration of endotracheal tube intubation (p < 0.05) and presenc e of nasogastric tube (p < 0.05). (3) Vocal cord immobility was observ ed in 16 patients (20%). Eight patients had true vocal cord immobility noted initially after extubation, and the remaining eight had true vo cal cord immobility an average of 4 weeks offer extubation. Initial an d delayed true vocal cord immobility were associated with duration of intubation and size of endotracheal tube (p < 0.01). Delayed true voca l cord immobility developed only in patients with a size 8 endotrachea l tube. Implications generated from this study would suggest the use o f antacids and histamine(2) receptor antagonist medications for patien ts requiring a nasogastric tube and the use of smaller diameter endotr acheal tubes.