A prospective study of laryngotracheal sequelae in long-term intubation.

A series of 200 patients having endotracheal intubation between 2 and 24 days were studied prospectively. The data was organized into 3 groups as follows: Group I: 2 to 5 days intubation, (50); Group II: 6 to 10 days intubation, (100); and Group III: 11 to 24 days intubation, (50). For the Group I population, the most significant injury is in the posterior commissure of the larynx which in this site leads to acute and chronic sequelae. At these intubation times, cuff site injury has not been prominent. Despite the selection of patients for conversion to tracheotomy in order to prevent complications, there is an increased incidence of significant sequelae in Group II population. A most noticeable trend accompanying the increased incidence is the changing nature of the resultant stenosis to include continuous damage from the posterior glottis through the cervical trachea. These trends become evident in those patients having intubation times greater that 7 days. In Group III population, the increased incidence, as well as the severity of post-intubation complications become clearly evident. Conversion to tracheotomy before serious organ disruption occurs at these prolonged intubation times is preventative.