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Post intubation laryngeal sequelae in an intensive care unit

Published online by Cambridge University Press:  29 June 2007

Ratna Thomas ,
E. Vijaya Kumar ,
Mohan Kameswaran ,
Ahmed Shamim ,
Saeed Al Ghamdii ,
Anil P. Mummigatty.  and
B. C. Okafor
Ratna Thomas
Affiliation:
Department of OtolaryngologyAsir Central Hospital, Abha
E. Vijaya Kumar
Affiliation:
Departments of AnaesthesiologyCollege of Medicine, King Saud University, Abha
Mohan Kameswaran*
Affiliation:
Departments of Otolaryngology, College of Medicine, King Saud University, Abha.
Ahmed Shamim
Affiliation:
Department of OtolaryngologyAsir Central Hospital, Abha
Saeed Al Ghamdii
Affiliation:
Departments of Otolaryngology, College of Medicine, King Saud University, Abha.
Anil P. Mummigatty.
Affiliation:
Departments of Otolaryngology, College of Medicine, King Saud University, Abha.
B. C. Okafor
Affiliation:
Departments of Otolaryngology, College of Medicine, King Saud University, Abha.
*
Address for correspondence: Dr Mohan Kameswaran, 458. IIIrd Avenue, Indira Nagar, Adayar. Madras 600020, India.
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Abstract

The incidence, severity and pattern of post-intubation laryngotracheal sequelae in a 12 bed multidisciplinary intensive care unit (ICU) were assessed in this prospective study. One-hundred and fifty consecutive patients requiring intubation for more than 24 hours for various indications were studied. Evaluation of the larynx and trachea was done using a fibreoptic bronchoscope introduced through the endotracheal tube prior to elective extubation. Rigid bronchoscopy and direct laryngoscopy were performed in very small children and adults requiring tracheostomy. One-hundred and thirty-one (87.6 per cent) patients had visible laryngeal pathology in the immediate post-extubation period. Thirteen (8.6 per cent) had long term sequelae. A high incidence of long term sequelae was noted in patients with seizures (25 per cent) followed by patients with head injury (19 per cent). Steroid therapy failed to offer any significant protection but resulted in doubling of pulmonary sepsis. A grading system was adopted to classify acute laryngotracheal injury and a significant correlation was found between the presence of slough in the immediate post-extubation period and subsequent development of long term sequelae. There was also a significant correlation between a deeper insertion of the endotracheal tube and development subsequently of long term sequelae. The significance of these findings is discussed.

Keywords

Intubationintratrachealcomplications
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 109 , Issue 4 , April 1995 , pp. 313 - 316
Copyright
Copyright © JLO (1984) Limited 1995

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