Acute laryngeal lesions following endotracheal intubation: risk factors, classification and treatment

2021 ◽  
pp. 151052
Author(s):  
Cláudia Schweiger ◽  
Denise Manica
Keyword(s):  
Risk Factors ◽  
Endotracheal Intubation ◽  
Laryngeal Lesions ◽  
Classification And Treatment

Prolonged Intubation Injuries of the Larynx: Endoscopic Diagnosis, Classification, And Treatment

2018 ◽  
Vol 127 (8) ◽  
pp. 492-507 ◽  
Author(s):  
Bruce Benjamin
Keyword(s):  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Granulation Tissue ◽  
Direct Laryngoscopy ◽  
Prolonged Intubation ◽  
Laryngeal Trauma ◽  
Flow Charts ◽  
Diagnosis Classification ◽  
Classification And Treatment

Laryngeal trauma from prolonged endotracheal intubation occurs in patients of all ages. Most changes are superficial and heal quickly. Injuries that are found consistently during intubation include nonspecific changes, edema, granulation tissue, ulceration, and othermiscellaneous injuries. In thispapersignificant, severe, and lasting trauma of the larynx has been classified on thebasis of theknown factors in pathogenesis, observations made atendoscopy, and photographic documentation. This classification has required introduction of new descriptive terminology: “tongues of granulation tissue,” “ulcerated troughs,” “healed furrows,” and “healed fibrous nodule.” During intubation the degree of injury can be precisely assessed under general anesthesia by using telescopes for image magnification, thus assisting adecision whether to continue intubation orperform tracheotomy to minimize long-term morbidity. Changes that are found after extubation result from granulation tissue, ulceration, ora combination of both and have been illustrated on flow charts; a knowledge and understanding of these sequelae allows them to be identified by both indirect and direct laryngoscopy so that treatment can be planned.

Dysphagia Following Prolonged Endotracheal Intubation: Is There A Rule of Thumb?

2014 ◽  
Vol 23 (2) ◽  
pp. 80-86
Author(s):  
James L. Coyle
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Mechanical Ventilation ◽  
Adverse Events ◽  
Endotracheal Intubation ◽  
Swallowing Disorders ◽  
Artificial Airway ◽  
Rule Of Thumb

Prolonged endotracheal intubation is a common iatrogenic cause of swallowing disorders. Clinicians frequently seek a decision-making algorithm to determine appropriate timing of assessment, predict the course of recovery, and determine the need for interventions. Many risk factors are present in any patient requiring mechanical ventilation through an artificial airway, making each case a complex and unique puzzle. This paper reviews the literature regarding effects of prolonged endotracheal intubation and risk factors for adverse events, and underscores the uncertainty inherent in management after extubation.

scholarly journals Prospective multi-center evaluation on risk factors, clinical characteristics and outcomes due to carbapenem resistance in Acinetobacter baumannii complex bacteraemia: experience from the Chinese Antimicrobial Resistance Surveillance of Nosocomial Infections (CARES) Network

2020 ◽  
Vol 69 (7) ◽  
pp. 949-959
Author(s):  
Yudong Liu ◽  
Qi Wang ◽  
Chunjiang Zhao ◽  
Hongbin Chen ◽  
Henan Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acinetobacter Baumannii ◽  
Endotracheal Intubation ◽  
Type Species ◽  
Clinical Characteristics ◽  
Carbapenem Resistance ◽  
Male Gender ◽  
Content Type ◽  
Link Type ◽  
All Cause Mortality

Introduction. Increasing evidence demonstrates unfavourable outcomes in bloodstream infections (BSI) due to the carbapenem-resistant Acinetobacter baumannii complex (CRAB). Aim. To investigate the differences in risk factors, clinical characteristics and outcomes in patients with A. baumannii complex BSI stratified by carbapenem resistance, a prospective multi-center study was conducted. Methodology. Information was collected in a predefined form. A total of 317 cases was included for comparison between CRAB BSI vs. carbapenem-susceptible A. baumannii complex (CSAB) BSI. Among these cases, 229 cases were defined as CRAB BSI and 88 cases as CSAB BSI. Results. Univariable analysis showed that male gender, underlying neurologic disease, prior carbapenems exposure, intensive care unit (ICU) stay, presence of central venous catheter, endotracheal intubation, tracheotomy, Foley catheter, nasogastric intubation, lower respiratory tract infections and catheter-related infections were more prevalent in CRAB BSI. Only male gender, prior carbapenems exposure and presence of endotracheal intubation persisted as independent risk factors for acquiring CRAB BSI. Patients with CRAB BSI displayed unfavourable outcomes characterized by failure of pathogen clearance, continuous fever, disease aggravation and higher incidence of 30-day all-cause mortality. Multivariate analysis demonstrated carbapenem resistance as an independent risk factor for 30-day all-cause mortality. Conclusion. Our findings reveal the epidemiological differences between CRAB BSI and CSAB BSI in a Chinese cohort. Our data suggest that carbapenem resistance has a significant impact on mortality for patients with A. baumannii complex BSI, further strengthening the importance of active prevention and control strategies for the spread of CRAB in Chinese hospitals.

scholarly journals Clinical Conditions and Risk Factors of Acinetobacter Baumannii Producing Metallo Beta-Lactamases Among Hospitalized Patients

2021 ◽  
Vol 2 (4) ◽  
pp. 11-17
Author(s):  
Sulaiman Alhusam
Keyword(s):  
Risk Factors ◽  
Endotracheal Intubation ◽  
Culture Media ◽  
Hospitalized Patients ◽  
Clinical Samples ◽  
Sensitivity Testing ◽  
Antimicrobial Sensitivity ◽  
Carbapenem Resistant ◽  
The Difference ◽  
Clinical Conditions

Purpose: The study aimed to determine the clinical conditions and risk factors associated with MBL produced by A.bumannii among hospitalized patients. Subjects and Methods: The clinical samples were collected from inpatients and subcultured on routine culture media for growth. Identification of bacteria along with antimicrobial sensitivity testing was done by VITEK®2 compact (bioMerieux). Isolates that were resistant to Meropenem and/or Imipenem were followed to detection of MBL by using metallo-β-lactamases by imipenem EDTA combined disc test (IMP-EDTA CDT) method. Demographic and clinical data of each patient were collected in terms of the type of infection, hospital-stay, associated factors, and outcome till discharge. Results: A number of 73(86.9%) isolates of A.baumannii were resistant to carbapenem. out of 73 carbapenem-resistant isolates, 64(87.7%) were found to be MBL positive. The patients with age more than 60 years i.e.  35.9% (23/64) were found to be more common in MBL positive isolates of A. baumannii. The difference in the distribution of MBL positive and MBL negative cases with endotracheal intubation and in Surgery during the last 30 days of incubation was found to be statistically significant. The mortality rate of patients infected by MBL positive isolates of A.baumannii was 12.5%. Conclusion: The MBL positive strains among carbapenem-resistant isolates of A.baumannii were high. endotracheal intubation and Surgery during the last 30 days were independently associated with MBL positive cases.

Risk Factors for and Outcomes Associated With Peri-Intubation Hypoxemia: A Multicenter Prospective Cohort Study

2020 ◽  
pp. 088506662096244
Author(s):  
Nathan J. Smischney ◽  
Ashish K. Khanna ◽  
Ernesto Brauer ◽  
Lee E. Morrow ◽  
Uchenna R. Ofoma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Endotracheal Intubation ◽  
Point Estimate ◽  
Mask Ventilation ◽  
Factors Associated ◽  
Icu Length Of Stay ◽  
Multicenter Prospective Cohort Study ◽  
Bag Mask Ventilation ◽  
Multicenter Prospective Cohort

Background: Little is known about hypoxemia surrounding endotracheal intubation in the critically ill. Thus, we sought to identify risk factors associated with peri-intubation hypoxemia and its effects’ on the critically ill. Methods: Data from a multicenter, prospective, cohort study enrolling 1,033 critically ill adults who underwent endotracheal intubation across 16 medical/surgical ICUs in the United States from July 2015-January 2017 were used to identify risk factors associated with peri-intubation hypoxemia and its effects on patient outcomes. We defined hypoxemia as any pulse oximetry ≤ 88% during and up to 30 minutes following endotracheal intubation. Results: In the full analysis (n = 1,033), 123 (11.9%) patients experienced the primary outcome. Five risk factors independently associated with our outcome were identified on multiple logistic regression: cardiac related reason for endotracheal intubation (OR 1.67, [95% CI 1.04, 2.69]); pre-intubation noninvasive ventilation (OR 1.66, [95% CI 1.09, 2.54]); emergency intubation (OR 1.65, [95% CI 1.06, 2.55]); moderate-severe difficult bag-mask ventilation (OR 2.68, [95% CI 1.72, 4.19]); and crystalloid administration within the preceding 24 hours (OR 1.24, [95% CI 1.07, 1.45]; per liter up to 4 liters). Higher baseline SpO2 was found to be protective (OR 0.93, [95% CI 0.91, 0.96]; per percent up to 97%). Consistent results were seen in a separate analysis on only stable patients (n = 921, 93 [10.1%]) (those without baseline hypoxemia ≤ 88%). Peri-intubation hypoxemia was associated with in-hospital mortality (OR 2.40, [95% CI 1.33, 4.31]; stable patients: OR 2.67, [95% CI 1.38, 5.17]) but not ICU length of stay (point estimate 0.9 days, [95% CI −1.0, 2.8 days]; stable patients: point estimate 1.5 days, [95% CI −0.4, 3.4 days]) after adjusting for age, body mass index, illness severity, airway related reason for intubation (i.e., acute respiratory failure), and baseline SPO2. Conclusions: Patients with pre-existing noninvasive ventilation and volume loading who were intubated emergently in the setting of hemodynamic compromise with bag-mask ventilation described as moderate-severe were at increased risk for peri-intubation hypoxemia. Higher baseline oxygenation was found to be protective against peri-intubation hypoxemia. Peri-intubation hypoxemia was associated with in-hospital mortality but not ICU length of stay. Trial registration: Clinicaltrials.gov identifier: NCT02508948 and Registered Report Identifier: RR2-10.2196/11101.

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