Patients with postintubation laryngeal injury who undergo earlier intervention after endotracheal intubation experience a greater decrease in the duration of tracheostomy dependence, have a higher rate of decannulation, and undergo fewer surgical procedures compared with patients who undergo later intervention after intubation, study results in JAMA Otolaryngology – Head & Neck Surgery suggest.
Researchers conducted a retrospective review of 29 patients with laryngeal injury associated with endotracheal intubation evaluated at a tertiary center between 2014 and 2018. A total of 10 patients with intubation injury to the posterior glottis underwent early intervention within a median of 25.9 days to presentation, while 19 patients with posterior glottic stenosis underwent late intervention within 288.8 days to presentation.
Early intervention was defined as an intervention performed 45 days or less after intubation, and late intervention was defined as a procedure performed more than 45 days following intubation. The early and late intervention groups were comparable in terms of age (median, 59.7 vs 53.8 years, respectively) and burden of comorbid medical illness (Charlson Comorbidity Index, 1.4 vs 1.7).
A total of 90% of patients in the early intervention group and 58% of patients in the late intervention group were decannulated at the last follow up (absolute difference, 32%; 95% CI, -3% to 68%). Early treatment was associated with needing fewer total interventions compared with patients who had more mature lesions (mean, 2.2 vs 11.5, respectively; absolute difference, 9.3; 95% CI, 6.4-12.1). None of the patients who underwent treatment early required an open procedure, but 90% who underwent late intervention required open procedures for decannulation.
Limitations of this study included its retrospective design, the small number of patients, as well as the observational nature of the data.
The investigators add that their findings may hold clinical relevance for “…the management of patients requiring an extended duration of endotracheal intubation during recovery for critical illness related to SARS-CoV-2 infection.”
Lowery AS, Malenke JA, Bolduan AJ, Shinn J, Wootten CT, Gelbard A. Early intervention for the treatment of acute laryngeal injury after intubation. JAMA Otolaryngol Head Neck Surg. Published online January 28, 2021. doi:10.1001/jamaoto.2020.4517