Long-term complications of artificial airways
Section snippets
Pathophsyiology
Long-term complications of artificial airways may occur as a result of the events surrounding the placement of the device itself, as a result of its prolonged residence in the airway, or as a result of events resulting in abnormal healing of the injured airway mucosa [1].
Specific considerations regarding the placement of an artificial airway include the conditions surrounding airway placement, the anatomical and physiological features of the patient, and characteristics related to the device
Long-term complications of endotracheal intubation
One of the earliest reports of prolonged endotracheal intubation was by MacEwen in 1880. It wasn't until the last 50 years, however, that more studies were performed investigating the long-term complications. These include hoarseness, sore throat, sinusitis, arytenoid dislocation, vocal cord paralysis, and laryngotracheal injury (Box 1). Overall the reported incidence of these complications ranges from 0% to 75%, illustrating the difficulty in categorizing these morbidities. Many studies
Long-term complications of tracheotomy
Tracheotomy is being used more frequently, especially in the critical care setting [124], [125]. Benefits include alleviating airway obstruction, improved secretion management, prevention of aspiration in an unprotected airway, and providing positive pressure ventilation.
Complications associated with long-term tracheotomy have ranged widely, with some studies reported an incidence of 65% [125], [126]. These complications are particularly difficult to quantify because many patients are
Summary
In summary, long-term complications of artificial airways are rare but important sequelae of artificial airways. Many of the potential long-term complications of translaryngeal intubation and tracheotomy are similar and overlapping. Although most patients who undergo these procedures tend to tolerate them without difficulties, significant morbidity and mortality may occur. Identifying the exact cause of the complication may not be possible at times, due to the multiple risk factors involved in
References (163)
- et al.
Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients
Am J Med
(1981) - et al.
Factors influencing acquired subgottic stenosis in infants
J Pediatr
(1986) - et al.
A low-pressure cuff for tracheostomy tubes to minimize tracheal injury. A comparative clinical trial
J Thorac Cardiovasc Surg
(1971) - et al.
Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery
Otolaryngol Head Neck Surg
(2002) - et al.
Postoperative sore throat after ambulatory surgery
Br J Anaesth
(2002) - et al.
Postoperative throat complaints after tracheal intubation
Br J Anaesth
(1994) - et al.
Postintubation phonatory insufficiency: an elusive diagnosis
Otolaryngol Head Neck Surg
(2001) - et al.
Recurrent laryngeal nerve paralysis. A 10-year review of 564 patients
Auris Nasus Larynx
(1983) Problems with prolonged endotracheal intubations
Chest
(1978)- et al.
Intubation granuloma
Otolaryngol Clin North Am
(1982)
Evaluation and management of bilateral vocal cord immobility
Otolaryngol Head Neck Surg
Virtual bronchoscopy
Clin Chest Med
Histopathology of endotracheal intubation. An autopsy study of 99 cases
Arch Pathol
A report of 342 cases of prolonged endotracheal intubation
Med J Aust
Prolonged endotracheal intubation
Acta Anaesthesiol Scand Suppl
Risk factors associated with prolonged intubation and laryngeal injury
Otolaryngol Head Neck Surg
Early complications of airway management in head-injured patients
Laryngoscope
Post intubation laryngeal sequelae in an intensive care unit
J Laryngol Otol
Histologic changes produced by endotracheal intubation
Ann Otol Rhinol Laryngol
Subglottic tracheal stenosis
Semin Thorac Cardiovasc Surg
Subglottic stenosis: a clinicopathological study
Clin Otolaryngol
Arytenoid dislocation: diagnosis and treatment
Laryngoscope
Iatrogenic ruptures of the tracheobronchial tree
Eur J Cardiothorac Surg
Laryngeal injury following short-term intubation
Ann Otol Rhinol Laryngol
L'arthrite crico-arytenoidienne: une cause d'obstruction des voies respiratoires superieures dans l'arthrite rhumatoide
Can J Anaesth
Acute cricoarytenoid arthritis: local periarticular steroid injection
Ann Otol Rhinol Laryngol
Sudden death from cord compression associated with atlanto-axial instability in rheumatoid arthritis. A case report
Spine
Prevention of complications from prolonged tracheal intubation
Am J Surg
Pressure on the tracheal mucosa from cuffed tubes
BMJ
Airway complaints and laryngeal pathology after intubation with an anatomically shaped endotracheal tube
Acta Anaesthesiol Scand
The conformity of an anatomically shaped endotracheal tube to the shape of the airway
Acta Anaesthesiol Scand
Endoscopic evolution of laryngeal injuries caused by translaryngeal intubation
Eur Arch Otorhinolaryngol
A prospective study of laryngotracheal sequelae in long-term intubation
Laryngoscope
Resolution of laryngeal injury following translaryngeal intubation
Am Rev Respir Dis
Laryngotracheal injury due to endotracheal intubation: incidence, evolution, and predisposing factors. A prospective long-term study
Crit Care Med
Size of endotracheal tube and neonatal acquired subglottic stenosis. Study Group for Neonatology and Pediatric Emergencies in the Parisian Area
Arch Otolaryngol Head Neck Surg
Nitrous oxide increases endotracheal cuff pressure and the incidence of tracheal lesions in anesthetized patients
Anesth Analg
Blood flow in the rabbit tracheal mucosa under normal conditions and under the influence of tracheal intubation
Acta Anaesthesiol Scand
A study of endotracheal tube injury to the subglottis
Laryngoscope
Acquired subglottic stenosis caused by methicillin resistant Staphylococcus aureus that produce epidermal cell differentiation inhibitor
Arch Dis Child Fetal Neonatal Ed
Role of infection in the development of acquired subglottic stenosis in neonates with prolonged intubation
Pediatr Int
The hazards of tracheostomy
Va Med Mon
Tracheostomy-related subglottic stenosis: bacteriologic pathogenesis
Laryngoscope
A management strategy for vocal process granulomas
Laryngoscope
Association of laryngopharyngeal reflux disease and subglottic stenosis
Ann Otol Rhinol Laryngol
The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury
Laryngoscope
Interview method affects incidence of postoperative sore throat
Anaesthesia
The influence of endotracheal tube cuff design and cuff lubrication on postoperative sore throat
Anesthesiology
Reduction of postoperative sore throat with new endotracheal tube cuffs
Anesthesiology
Cited by (144)
Photomodulative effects of low-level laser therapy on tracheal fenestration developed in in vivo model
2023, Journal of Photochemistry and Photobiology B: BiologyIf at First You Do Not Succeed: Consideration of Attempts in Patients With Trauma
2023, Journal of Surgical ResearchCombinatorial prophylactic effect of phlorotannins with photobiomodulation against tracheal stenosis
2022, iScienceCitation Excerpt :Recently, the number of patients who have undergone tracheostomy or intubation has increased because of the spread of coronavirus disease (COVID-19), and a large number of studies have been conducted on tracheal stenosis for efficient management after the procedure.5,6,7,8,9 Several surgical options (e.g., balloon dilation, bronchoscopy, and tracheal resection) are currently in use to improve airway patency depending on the degree of stenosis.1,10 Nonetheless, patients still suffer from breathing interference because of restenosis after these treatment methods.
Impact of tracheostomy invasive ventilation on survival in Japanese patients with multiple system atrophy
2022, Parkinsonism and Related DisordersSwallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis
2021, Journal of Heart and Lung TransplantationCitation Excerpt :Laryngotracheal injuries in this population are common, with the present authors previously reporting dysphonia in 63% of patients referred to speech pathology following transplantation.42 Intubation related injuries include granulomas, stenosis, infections, glottic and subglottic oedema and vocal fold motion abnormalities due to arytenoid dislocation or nerve damage.45,57-60 Injury can occur at the time of tube placement, due to prolonged presence of the tube in the airway or at a later stage due to abnormal healing of the airway mucosa.