This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Background: Endotracheal intubation is a routinely performed procedure in the intensive care unit. While it is recognized that endotracheal intubation can result in laryngeal and tracheal injury, this study evaluated factors that may affect the incidence of posterior vocal cord ulcers (PVCU).
Methods: 1,355 subjects were retrospectively screened from 2002 through 2018 that received a tracheostomy with routine bronchoscopy at a single institution. Post tracheostomy operative notes were reviewed and included only if proper visualization of the vocal cords were documented. Primary outcome measures included presence of PVCU, length of time on a ventilator until a tracheostomy, length of hospitalization stay, and mortality. Stratification of the data focused on the severity of the ulcer (Mild, Moderate, and Severe) and was analyzed using analysis of variance (ANOVA). Multivariate analysis and Kaplan-Meier modeling of PVCU incidence over time.
Results: 192 of 1,355 subjects had documentation of vocal cord visualization. 39 subjects did not have a posterior vocal cord ulcer, while 153 subjects did. A median duration of 9 days (IQR 5–13) was associated with developing a mild PVCU while individuals intubated for a median of 6 days (IQR 4–7) were ulcer free. Statistical difference between length of time on a ventilator before tracheostomy and the severity of the PVCU seen was significant (P <.001). The Kaplan-Meier model showed that beyond 2 weeks of endotracheal intubation, subjects will have greater than 80% chance of developing a moderate vocal cord ulcer. Whereas by day 7, there is only a 20% chance of developing a moderate ulcer.
Conclusion: This study has shown that earlier tracheostomy placement is associated with reduced severity of vocal cord ulcer formation. Kaplan-Meier Model suggest that waiting for 14 days is likely too long and earlier placement of a tracheostomy, within a week, may decrease the morbidity of posterior vocal cord injury.
Footnotes
- Corresponding Author:
David T. Wong, MD, FACS, FCCP, davewo{at}msn.com
- Received March 24, 2022.
- Accepted June 27, 2022.
- Copyright © 2022 by Daedalus Enterprises
Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$30.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.
