Abstract
Background:
Endotracheal intubation is a life-saving intervention performed in the setting of respiratory failure. While injury to the vocal cords is known, there is limited information in the literature on tracheal injuries secondary to endotracheal intubation. Patient positioning, cuff pressure, tube positioning, and pressure exerted on the tube by the tongue can cause the endotracheal tube to follow a sigmoidal path through the airway, causing the tip of the endotracheal tube to rest on the tracheal wall and potentially putting the patient at risk of injury. However, the development of low pressure cylindrical cuffed flexible endotracheal tubes can mitigate injuries found at the tip and cuff of the endotracheal tube. This study investigates the development of endotracheal tip and cuff ulcers in ICU patients as observed at the time of tracheostomy placement.
Methods:
An IRB approved retrospective cohort study was conducted on 1,355 patients who underwent tracheostomy from 2002–2018. Tracheal ulcers were documented during percutaneous tracheostomy placement. Patients were excluded if tracheal ulcers were not documented by bronchoscopy. Demographic data was collected. Primary outcome measures included length of time on a ventilator until tracheostomy (LOVT), length of hospitalization (LOH), and mortality. Data was reported as n (%) and median (IQR). Differences in means between groups were analyzed by ANOVA with alpha of 0.05.
Results:
Chart review of 206 patients revealed 65 subjects without tracheal ulcers and 141 patients with tracheal ulcers. Patients with tracheal ulcers were grouped by severity: no ulcer, mild - minimal mucosal erosion with exudate, moderate - mucosal erosion, severe - tracheal ring exposure. Comparison of demographic data revealed no statistically significant differences in age (P = 0.99), gender (P = 0.83), BMI (P = 0.44), LOH (P = 0.88), LOVT (P = 0.93), and mortality (P = 0.306) between patients with differing severity of ulcers. The average yearly incidence of clinically significant ulcers (moderate and severe) was 2.2%.
Conclusions:
In our limited cohort, there was no statistically significant difference in age, gender, LOH, LOVT, BMI, and mortality between patients with different severity of tracheal ulcers due to intubation. The lack of statistical difference amongst severity and demographic data, along with a low average yearly incidence of 2.2%, supports the safety of low pressure cylindrical cuffed flexible endotracheal tubes on tracheal injuries.
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