Meenan Kirsten, Bhatnagar Kavita, Guardiani Elizabeth
Department of Otolaryngology, University of Maryland School of Medicine, Baltimore, MD, USA.
Ann Otol Rhinol Laryngol. 2021 Sep;130(9):1078-1084. doi: 10.1177/0003489421995285. Epub 2021 Feb 15.
To identify the incidence and risk factors for intubation-related laryngeal lesions that preclude tracheostomy decannulation in a large population.
A 3-year retrospective case-control study was performed of tracheotomized adults in acute rehabilitation facilities who underwent routine endoscopic evaluation of the airway as part of the facilities' decannulation protocol. Patients with known upper airway pathology, external laryngeal trauma, cricothyrotomy or emergent tracheostomy, prior head and neck radiation, isolated tracheal lesions, and patients with incomplete reports were excluded. The laryngeal pathologies were classified, and demographics and clinical features were compared between those whose lesions precluded decannulation and all other patients.
Three hundred seventy-one patients met inclusion criteria. One hundred six (28.6%) had laryngotracheal lesions. Forty-nine patients (13.2%) had intubation-related lesions of the larynx that precluded decannulation. These lesions included posterior glottic stenosis (30.6%), granulation tissue (24.5%), vocal fold immobility (16.3%), subglottic stenosis (16.3%), a combination of granulation tissue and stenosis (10.2%), and glottic edema (2.0%). A BMI ≥ 25 kg/m was associated with laryngeal lesions precluding decannulation. There was no difference in age, sex, race, diabetes mellitus, endotracheal tube size, number of days intubated, and number of intubations between groups. Seventy-eight percent of patients with lesions precluding decannulation were decannulated after medical or surgical therapy. The decannulation rate of patients without lesions precluding decannulation was 79.9%.
BMI ≥ 25 kg/m may increase the risk of development of laryngeal lesions preventing decannulation. Given that 13.2% of tracheotomized patients have laryngeal lesions precluding decannulation, an endoscopic evaluation of the airway is important to prevent decannulation failure and future airway symptoms.
确定在大量人群中妨碍气管造口脱管的插管相关喉部病变的发生率及危险因素。
对急性康复机构中接受气管切开的成年患者进行了一项为期3年的回顾性病例对照研究，这些患者作为机构脱管方案的一部分接受了常规气道内镜评估。排除已知有上气道病变、喉外部创伤、环甲膜切开术或紧急气管造口术、既往头颈部放疗、孤立性气管病变以及报告不完整的患者。对喉部病变进行分类，并比较病变妨碍脱管的患者与所有其他患者的人口统计学和临床特征。
371例患者符合纳入标准。106例（28.6%）有喉气管病变。49例（13.2%）有插管相关的喉部病变妨碍脱管。这些病变包括声门后狭窄（30.6%）、肉芽组织（24.5%）、声带固定（16.3%）、声门下狭窄（16.3%）、肉芽组织与狭窄并存（10.2%）和声门水肿（2.0%）。BMI≥25kg/m与妨碍脱管的喉部病变相关。两组之间在年龄、性别、种族、糖尿病、气管内导管尺寸、插管天数和插管次数方面无差异。78%的病变妨碍脱管的患者在接受药物或手术治疗后脱管。无病变妨碍脱管的患者脱管率为79.9%。
BMI≥25kg/m可能增加发生妨碍脱管的喉部病变的风险。鉴于13.2%的气管切开患者有妨碍脱管的喉部病变，气道内镜评估对于防止脱管失败和未来气道症状很重要。
