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Laryngeal Findings and Aspiration Risk after Prolonged Endotracheal Intubation in Adult Patients

Hatem Ezzeldin Hassan, Hossam I El Desouky and Mohamed Elsayed Saud

Background: Prolonged endotracheal intubation (more than forty eight hours) is needed in critically ill patients after respiratory failure. Prolonged intubation are usually associated with different laryngeal injures as vocal fold immobility, ulceration, granulomas and edema. Objectives: To determine the effects of prolonged endotracheal intubation on the larynx & to assess swallowing ability and presence of aspiration in selected patients. Patients and Methods: This study was conducted on 54 patients with endotracheal intubation admitted to adult Intensive Care Unit (ICU). When the patients were eligible for endotracheal extubation. The patients evaluated immediately after extubation or within 24 hours. The patients evaluated by flexible fibroptic-naso-laryngoscope with endoscopic video-recording for the presence of vocal fold lesions. Also, some patients assessed for swallowing ability and presence of aspiration. Results: Laryngeal abnormalities were seen in 85% of patients on the day of extubation. Majority of patients (42.6%) had posterior glottal contusions and laceration, followed by vocal fold immobility (25.9%) and subglottal edema (22.2%). Also subglottic web and stenosis were found in (14.8%). 30 patients were assessed for swallowing difficulty. Laryngeal spiration was detected in 66% of those patients. Conclusion: Prolonged laryngeal intubation was associated with different laryngeal injuries. Size of tubes and duration of intubation are correlated with the severity & number of laryngeal lesions. High risk of aspiration was observed after prolonged laryngeal intubation.