Endoscopic diagnosis of laryngeal injury following endotracheal intubation

Secondary changes in the laryngeal mucosa due to endotracheal intubation are inevitable. Degree of these pathological changes depend on some factors such as duration of intubation, size of tube, general status of patient, presence of infection. To prevent any irreversible sequelae of intubation, it is important to diagnose these changes as soon as early [1, 2]. Purpose of these studies was evaluation of laryngeal injury in a group of patients who had intubations for more than 4 days in ICU.

Fourteen patients (4 female, 10 male) suffering from respiratory insufficiency or neurological disorder were included in the study. All patients were orally intubated by polyvinyl-cuffed, low-pressure, high volume endotracheal tubes (sizes 7.5–8.0 mm) and ventilated. Nasogastric tube placed all of them. Endoscopic examinations were made by fiber or rigid laryngeal endoscope (0°–30° angled telescope) in 6 cases when the endotracheal tube was replaced by a tracheotomy cannula, and in 8 cases after immediate extubation or decannulation. Photographic documentation of each one was collected and laryngeal injuries were evaluated.

Total duration of intubation was 10.6 ± 1.4 (4–24) days. Endoscopic signs of injuries of laryngeal mucosa due to intubation were edema (28%), granuloma (14%), ulceration (42%) and fibrosis (7%). All of the ulceration was seen in posterior commissura and interarytenoid areas. Edema was determined on arytenoids, aryepiglottic fold and membranous part of the vocal cords. Granuloma were detected on anterior part of the vocal cords and finally fibrosis was seen in posterior subglottic area.

As a conclusion of this preliminary study, incidence of the injury of laryngeal mucosa due to intubation was very high (64%). The most frequent pathologic finding was ulceration. Endoscopic examination is the best way to diagnose these lesions.