Alalyani Nasser Saad, Alhedaithy Alhanouf Abdulaziz, Alshammari Hind Khaled, AlHajress Rafeef I, Alelyani Rakan H, Alshammari Malak Fawaz, Alhalafi Abdullah Hassan, Alharbi Amani, Aldabal Nada
Department of Otolaryngology, Head and Neck Surgery, King Fahd Military Medical Complex, Dhahran, SAU.
Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins Aramco Healthcare, Dhahran, SAU.
Cureus. 2024 Aug 27;16(8):e67917. doi: 10.7759/cureus.67917. eCollection 2024 Aug.
Endotracheal intubation carries risks, including arytenoid dislocation (AD), a rare but severe complication. Due to small sample sizes, the incidence of AD varies considerably among studies. Proposed risk factors for AD include difficult intubation, prolonged intubation, certain surgeries, patient positioning, female sex, and BMI. This review aims to investigate the incidence of AD and explore the various predisposing risk factors. We retrieved relevant studies up to April 2024 from PubMed, Scopus, Web of Science, and the Cochrane Library. Using OpenMeta v5.26.14 software (Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, USA), we pooled AD incidence rates from individual studies. Other outcomes, reported in fewer studies and thus not suitable for meta-analysis, were synthesized manually. Study selection yielded 16 eligible articles. A random-effects model analysis of nine studies found a significant AD incidence rate of 0.093% (confidence interval (CI): 0.045% to 0.14%), but the results were highly heterogeneous (I = 91%). Older age was associated with prolonged hoarseness, while younger age and female sex increased the risk of AD. Additionally, AD risk factors included taller stature, higher BMI, specific surgeries, esophageal instrumentation, prolonged procedure durations, head-neck movement, and inexperienced intubators. However, intubation with a stylet reduced the AD risk. AD post-endotracheal intubation is rare (incidence: 0.09%), with potential underdiagnosis in larger datasets. Many risk factors may contribute to the condition, but the small number of studies per risk factor limits the ability to draw robust conclusions. Subjective diagnoses and retrospective studies further restrict comprehensive understanding. Further research is needed to explore AD risk factors effectively.
气管插管存在风险，包括杓状软骨脱位（AD），这是一种罕见但严重的并发症。由于样本量较小，AD的发生率在不同研究中差异很大。AD的潜在风险因素包括插管困难、插管时间延长、某些手术、患者体位、女性性别和体重指数。本综述旨在调查AD的发生率，并探讨各种诱发风险因素。我们从PubMed、Scopus、Web of Science和Cochrane图书馆检索了截至2024年4月的相关研究。使用OpenMeta v5.26.14软件（美国波士顿塔夫茨医学中心临床研究与健康政策研究所），我们汇总了各研究的AD发生率。其他结果在较少的研究中报告，因此不适合进行荟萃分析，采用人工合成的方法。研究筛选出16篇符合条件的文章。对9项研究的随机效应模型分析发现，AD的发生率为0.093%（置信区间（CI）：0.045%至0.14%），但结果高度异质性（I² = 91%）。年龄较大与声音嘶哑持续时间延长有关，而年龄较小和女性性别则增加了AD的风险。此外，AD的风险因素包括身材较高、体重指数较高、特定手术、食管器械操作、手术时间延长、头颈部活动以及插管经验不足。然而，使用管芯插管可降低AD风险。气管插管后发生AD的情况很少见（发生率：0.09%），在较大的数据集中可能存在漏诊。许多风险因素可能导致这种情况，但每个风险因素的研究数量较少，限制了得出有力结论的能力。主观诊断和回顾性研究进一步限制了全面理解。需要进一步研究以有效探索AD的风险因素。
