Nashville, Tennessee: Early intervention for the treatment of laryngeal injury after intubation may minimize fibrotic scar formation, disrupt the natural course of this disease, and limit long-term physiological impairment, finds a recent study.
The findings of the study, published in the journal JAMA Otolaryngology-Head & Neck Surgery, are relevant for the management of critical illness related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who extended durations of endotracheal intubation.
Patient who get laryngeal injury after endotracheal intubation often present long after initial injury with mature fibrosis compromising cricoarytenoid joint mobility and glottic function. Anne S. Lowery, Vanderbilt University School of Medicine, Nashville, Tennessee, and colleagues aimed to compare functional outcomes between early and late intervention for intubation-related laryngeal injury.
For the purpose, the researchers performed a retrospective cohort study involving 29 patients with laryngeal injury from endotracheal intubation. They were evaluated at a tertiary care center between May 1, 2014, and June 1, 2018. The researchers compared ten patients with intubation injury to the posterior glottis who received early treatment with 19 patients presenting with posterior glottic stenosis who received late treatment.
Early intervention was defined as a procedure performed 45 days or less after intubation, and late treatment, defined as an intervention performed greater than 45 days after intubation.
Patient-specific and intervention-specific covariates were compared between the 2 groups, absolute differences with 95% CIs were calculated, and time to tracheostomy decannulation was compared using log-rank testing.
Key findings of the study include:
The 2 groups had similar demographic characteristics and a similar burden of comorbid disease.
Nine of 10 patients (90%) who received early intervention and 11 of 19 patients (58%) who received late interventions were decannulated at last follow-up (absolute difference, 32%).
Patients who received early treatment required fewer total interventions than patients with mature lesions (mean, 2.2 vs 11.5; absolute difference, 9.3).
None of the patients who received early treatment required an open procedure, whereas 17 patients (90%) with mature lesions required open procedures to pursue decannulation.
"This study suggests that early intervention for patients with postintubation laryngeal injury was associated with a decreased duration of tracheostomy dependence, a higher rate of decannulation, and fewer surgical procedures compared with late intervention," wrote the authors. "Patients who underwent early intervention also avoided open reconstruction."
"indings may bear relevance to the management of patients requiring extended durations of endotracheal intubation during recovery for critical illness related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection," they concluded.
Reference:
The study titled, "Early Intervention for the Treatment of Acute Laryngeal Injury After Intubation," is published in the journal JAMA Otolaryngology-Head & Neck Surgery.
DOI: https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2775609