Chest
Volume 89, Issue 2, February 1986, Pages 165-167
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Clinical Investigations
Acute Complications of Endotracheal Intubation: Relationship to Reintubation, Route, Urgency, and Duration

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Sixty-one consecutive medical intensive care unit patients who were intubated for more than three days were prospectively studied for complications. Patients who were reintubated had a higher incidence of all complications (χ2= 5.4; p<.025), as did those with prolonged intubation2=16.1; p<.005). Neither route nor urgency had an adverse clinical effect. In contrast there was a 13 percent incidence of acute tracheolaryngeal complications, but no association was found with reintubation, route, urgency, or total duration of endotracheal intubation.

Section snippets

METHODS

Sixty-one consecutive patients who were intubated for more than three days were prospectively studied at the University of Cincinnati Medical Intensive Care Unit from July 1983 through June 1984. They were followed up either to hospital discharge or death. The patients were cared for in the medical ICU by a medical team consisting of the attending physician, pulmonary fellow, and house officers. Cuff pressures were routinely checked every four hours, with an accepted limit of 25 mm Hg. Cuffs

RESULTS

In the group of 61 patients, 34 were men, and 27 were women. The age range was 19 to 93, with a mean age of 60.3 years. The overall hospital survival for the group was 38 percent. Eleven patients (18 percent) subsequently required tracheostomy. The duration of endotracheal intubation prior to tracheostomy was 12.4±3.3 days (mean± SD). In this group, five were successfully extubated, five died, and one required a permanent tracheostomy.

Thirty patients (49 percent) had at least one complication (

DISCUSSION

Tracheal intubation is a common procedure performed in a busy medical intensive care unit. Both short-term and long-term sequelae have been reported.6 Since the introduction of the high-volume, low-pressure cuff, several studies have attempted to identify better risk factors leading to tracheolaryngeal injury, including duration,7, 8, 9 cuff pressure,1, 10 size of tube to larynx,11 tube movement,12 and trauma.13 The best predictor seems to be cuff pressure.10

Of the factors investigated, we find

ACKNOWLEDGMENT

The authors wish to thank Dr. Irwin Hanenson for his help in implementing the study and Dr. Robert G. Loudon for his careful review of the manuscript.

REFERENCES (18)

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Manuscript received February 22; revision accepted September 3.

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