Clinical study
Complications and consequences of endotracheal intubation and tracheotomy: A prospective study of 150 critically ill adult patients

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Abstract

A prospective study of the complications and consequences of translaryngeal endotracheal intubation and tracheotomy was conducted on 150 critically ill adult patients. Adverse consequences occurred in 62 percent of all endotracheal intubations and in 66 percent of all tracheotomies during placement and use of the artificial airways. The most frequent problems during endotracheal intubation were excessive cuff pressure requirements (19 percent), self-extubation (13 percent) and inability to seal the airway (11 percent). Patient discomfort and difficulty in suctioning tracheobronchial secretions were very uncommon. Problems with tracheotomy included stomal infection (36 percent), stomal hemorrhage (36 percent), excessive cuff pressure requirements (23 percent) and subcutaneous emphysema or pneumomediastinum (13 percent). Complications of tracheotomy were judged to be more severe than those of endotracheal intubation. Follow-up studies of survivors revealed a high prevalence of tracheal stenosis after tracheotomy (65 percent) and significantly less after endotracheal intubation (19 percent) (p < 0.01). Thirty-nine of 41 (95 percent) patients with endotracheal intubation and 20 of 22 (91 percent) patients with tracheotomy had laryngotracheal injury at autopsy. Ulcers on the posterior aspect of the true vocal cords were found at autopsy in 51 percent of the patients who died after endotracheal intubation. There was no significant relationship between the duration of endotracheal intubation or tracheotomy and the over-all amount of laryngotracheal injury at autopsy, although patients with prolonged endotracheal intubation followed by tracheotomy had more laryngeal injury at autopsy (P = 0.06) and more frequent tracheal stenosis (P = 0.05) than patients with short-term endotracheal intubation followed by tracheotomy. Adverse effects of both endotracheal intubation and tracheotomy are common. The value of tracheotomy when an artificial airway is required for periods as long as three weeks is not supported by data obtained in this study.

References (76)

  • V Kambic et al.

    Intubation lesions of the larynx

    Br J Anaesth

    (1978)
  • CO Brantigan et al.

    Cricothyroidotomy: elective use in respiratory problems requiring tracheotomy

    J Thorac Cardiovasc Surg

    (1976)
  • DB Mathias et al.

    The effects of cuffed endotracheal tubes on the tracheal wall

    Br J Anaesth

    (1974)
  • WM Shelly et al.

    Cuffed tubes as a cause of tracheal stenosis

    J Thorac Cardiovasc Surg

    (1969)
  • HC Grillo

    The management of tracheal stenosis following assisted respiration

    J Thorac Cardiovasc Surg

    (1969)
  • FR Lewis et al.

    Prevention of complications from prolonged tracheal intubation

    Am J Surg

    (1978)
  • NP Ching et al.

    The contribution of cuff volume and pressure in tracheostomy tube damage

    J Thorac Cardiovasc Surg

    (1971)
  • K Little et al.

    Tissue reactions to polymers

    Lancet

    (1962)
  • JB Johnston et al.

    Tracheal stenosis following tracheostomy: a conservative approach to treatment

    J Thorac Cardiovasc Surg

    (1967)
  • VF Blanc et al.

    The complications of tracheal intubation: a new classification with a review of the literature

    Anesth Analg (Cleve)

    (1974)
  • JW Meade

    Tracheotomy—its complications and their management: a study of 212 cases

    N Engl J Med

    (1961)
  • C-E Lindholm

    Prolonged endotracheal intubation

    Acta Anaesth Scand

    (1969)
  • MJ Andrews et al.

    Incidence and pathogenesis of tracheal injury following cuffed tube tracheostomy with assisted ventilation: analysis of a two-year prospective study

    Ann Surg

    (1971)
  • EL Applebaum et al.

    Complications of tracheal intubation

  • HH Timmis

    Tracheostomy: an overview of implications, management and morbidity

    Adv Surg

    (1973)
  • RMA McClelland

    Complications of tracheostomy

    Br Med J

    (1965)
  • GR Freeman

    A comparative analysis of endotracheal intubation in neonates, children, and adults: complications, prevention, and treatment

    Laryngoscope

    (1972)
  • H Pontoppidan et al.

    Acute respiratory failure in the adult

    N Engl J Med

    (1972)
  • RS Deane et al.

    Prolonged nasotracheal intubation in adults: a successor and adjunct to tracheostomy

    Anesth Analg (Cleve)

    (1970)
  • M El-Naggar et al.

    Factors influencing choice between tracheostomy and prolonged translaryngeal intubation in acute respiratory failure

    Anesth Analg (Cleve)

    (1976)
  • H Stoeckel

    Late complications after tracheostomy

  • HRS Harley

    Laryngotracheal obstruction complicating tracheostomy or endotracheal intubation with assisted respiration: a critical review

    Thorax

    (1971)
  • FH McGovern et al.

    The hazards of endotracheal intubation

    Ann Otol

    (1971)
  • IA Davidson et al.

    Lesions of the trachea following tracheostomy and endotracheal intubation

  • GR Sellery et al.

    Late complications of prolonged tracheal intubation

    Can Anaesth Soc J

    (1978)
  • FA Figi

    Tracheotomy: a study of 200 consecutive cases

    Ann Otol Rhinol Laryngol

    (1934)
  • HS Davis et al.

    Advantages and complications of tracheotomy

    JAMA

    (1953)
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    Present address: Veteran Administration Medical Center, 2615 East Clinton Avenue, Fresno, California, 93703.

    1

    From the Division of Pulmonary Sciences, University of Colorado Medical Center and the Veterans Administration Hospital, Denver, Colorado.

    Present address: Veterans Administration Center, 2215 Fuller Road, Ann Arbor, MI 48105.

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