OBJECTIVE: Tracheal intubation may represent a life-saving supportive measure in many acutely poisoned patients. Although considered as a safe procedure, intubation may rapidly damage laryngeal mucosa. The incidence and nature of short-duration intubation-associated laryngeal injuries are unknown in the population of poisoned patients. METHODS: We designed a prospective clinical investigation to study intubation-related laryngeal complications in poisonings. All consecutive intubated poisoned patients admitted over a 20-month period in our toxicological intensive care unit in a teaching hospital were included in this study. Daily clinical observation and laryngeal fiberscopic evaluation were performed to assess intubation-related laryngeal complications. RESULTS: We included 266 consecutive poisoned patients who had been intubated [116M/150F; age 41 years (31-53); median (25-75% percentiles); simplified acute physiology score II 43 (32-51); intubation time 24 h (13-52)]. Intubation was mainly performed at the scene (69%) and depended on the level of coma (89%). Complications included postextubation laryngeal dyspnea (9%) requiring mandatory reintubation (2%). Laryngoscopy was performed in 209 patients (79%) within 24 h after extubation. Eighty percent of patients presented significant initial laryngeal lesions. Stepwise logistic regression showed that two variables were predictive of injuries: female gender (odds ratio: 2.6; 95% confidence interval: 1.3-5.3) and intubation time > or =72 h (odds ratio: 6.4; confidence interval: 1.5-27.6). Overall, injuries were independent of age, severity of illness, coma level, vital signs, intoxicants, and intubation modalities. The most severe injuries were significantly associated with intubation time (p < 0.001) and simplified acute physiology score II (p = 0.04). Within 24 h following extubation, persistent dysphonia (p < 0.0001), dysphagia (p < 0.0001), or pharyngeal pain (p = 0.02) were predictive of laryngeal injury. CONCLUSIONS: Despite short-duration intubation, poisoned patients are at high risk of initial laryngeal injury.
OBJECTIVE: Tracheal intubation may represent a life-saving supportive measure in many acutely poisoned patients. Although considered as a safe procedure, intubation may rapidly damage laryngeal mucosa. The incidence and nature of short-duration intubation-associated laryngeal injuries are unknown in the population of poisoned patients. METHODS: We designed a prospective clinical investigation to study intubation-related laryngeal complications in poisonings. All consecutive intubated poisoned patients admitted over a 20-month period in our toxicological intensive care unit in a teaching hospital were included in this study. Daily clinical observation and laryngeal fiberscopic evaluation were performed to assess intubation-related laryngeal complications. RESULTS: We included 266 consecutive poisoned patients who had been intubated [116M/150F; age 41 years (31-53); median (25-75% percentiles); simplified acute physiology score II 43 (32-51); intubation time 24 h (13-52)]. Intubation was mainly performed at the scene (69%) and depended on the level of coma (89%). Complications included postextubation laryngeal dyspnea (9%) requiring mandatory reintubation (2%). Laryngoscopy was performed in 209 patients (79%) within 24 h after extubation. Eighty percent of patients presented significant initial laryngeal lesions. Stepwise logistic regression showed that two variables were predictive of injuries: female gender (odds ratio: 2.6; 95% confidence interval: 1.3-5.3) and intubation time > or =72 h (odds ratio: 6.4; confidence interval: 1.5-27.6). Overall, injuries were independent of age, severity of illness, coma level, vital signs, intoxicants, and intubation modalities. The most severe injuries were significantly associated with intubation time (p < 0.001) and simplified acute physiology score II (p = 0.04). Within 24 h following extubation, persistent dysphonia (p < 0.0001), dysphagia (p < 0.0001), or pharyngeal pain (p = 0.02) were predictive of laryngeal injury. CONCLUSIONS: Despite short-duration intubation, poisoned patients are at high risk of initial laryngeal injury.
Authors: Martin B Brodsky; Matthew J Levy; Erin Jedlanek; Vinciya Pandian; Brendan Blackford; Carrie Price; Gai Cole; Alexander T Hillel; Simon R Best; Lee M Akst Journal: Crit Care Med Date: 2018-12 Impact factor: 7.598
Authors: Ylinne T Lynch; Brendan J Clark; Madison Macht; S David White; Heather Taylor; Tim Wimbish; Marc Moss Journal: J Crit Care Date: 2017-02-15 Impact factor: 3.425