News HIV/AIDS News & Information - Part 8

02 Jan

Laryngeal Complications of Prolonged Intubation: Discussion

Laryngeal Complications of Prolonged Intubation: DiscussionThis prospective study of patients experiencing TLI for more than four continuous days confirms earlier reports on the incidence of transient and chronic- hoarseness postextubation. Chronic hoarseness may develop because of either vocal cord granulomas developing at the site of TLI-induced ulcerations or laryngeal stenosis. All four patients with chronic hoarseness in this series were documented to have vocal cord granulomas. Unlike Whiteds series, none of our patients developed progressive laryngeal scarring or stenosis during the extended follow-up. Stridor developed in 6 percent of the patients in this study, an incidence similar to previous studies in which patients had TLI for less than four days- and for longer period of time. Continue Reading »

01 Jan

Laryngeal Complications of Prolonged Intubation: Adverse Effects

Table 5 shows the proportion of patients with severe adverse effects and with chronic hoarseness alone by levels of initial laryngeal pathology. About 7 percent of patients developed chronic hoarseness independent of their initial pathology (relative risk =1.1; p>0.8). Patients with no or mild initial pathology did not develop severe adverse effects. Moderate and severe initial pathology were associated with severe adverse effects in only 19 percent of patients. The time course of resolution of the laryngeal damage in the 54 patients completing the follow-up aspect of the study is shown in Figure 3. The majority of the patients with initial laryngeal damage (31 of 49) had a normal larynx four weeks after extubation. Four patients developed granulomas at the site of laryngeal ulceration which persisted at least four months. Continue Reading »

05 Dec

Laryngeal Complications of Prolonged Intubation: Initial Laryngeal Damage

Laryngeal Complications of Prolonged Intubation: Initial Laryngeal DamageThe univariate relative risks of moderate or severe initial laryngeal damage for each baseline variable are reported in Table 3. Risks were higher for patients with longer duration of TLI and for those undergoing tracheostomy, and lower for the five patients identified as having flaccid paralysis throughout the duration of TLI (one following massive stroke, one after a craniotomy for subdural hematoma, and three with severe metabolic encephalopathy). Multivariate analysis indicated that only performance of a tracheostomy (p = 0.006) and persistent neuromotor activity (p<0.05) were associated with moderate to severe initial pathology. The adjusted odds of experiencing moderate to severe laryngeal pathology were 6.7 times higher for patients with a tracheostomy than for those not undergoing this procedure. this
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04 Dec

Laryngeal Complications of Prolonged Intubation: Results

Eighty-six patients met the entry criteria for this study. Four patients were excluded: one refused to enter the study, one was not entered because high grade ventricular ectopy prevented laryngoscopy, and two had incomplete records. The 82 study patients were all men with a mean age of 64.3 ±1.2 (SEM) years (range, 25 to 88 years). Their mean duration of TLI prior to extubation or tracheostomy was 9.7 ± 0.6 (SEM) days (range, four to 28 days). Twenty-eight patients completed only the initial evaluation. Nine of these 28 required reintubation and the other 19, eight of whom required tracheostomy, died before the first two-week assessment from clinical problems other than related to laryngeal pathology. Data from these patients could not be used to evaluate the occurrence of adverse clinical effects because follow-up was necessarily incomplete. Continue Reading »

03 Dec

Laryngeal Complications of Prolonged Intubation: Patient Care

Laryngeal Complications of Prolonged Intubation: Patient CarePatient Care
Medical care throughout the course of the patients’ illness was provided by house officers and attending staff from the University of South Florida College of Medicine. Translaryngeal intubations were primarily performed by these house officers, who had widely varying skills in this technique. Respiratory therapists provided the same respiratory care techniques in all three intensive care units. Tracheal tubes placed translaryngeally were taped securely in position close to the mouth or nose. All tracheal tubes were Z-79 approved and single-use. Two-way swivel adaptors and elastic latex connectors were interposed between the tracheal tube and attached tubing. Attached tubing was kept to a minimum and suspended by support arms. comments
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02 Dec

Laryngeal Complications of Prolonged Intubation: Methods

The adequacy of the gag reflex was assessed in these patients by the need for topical anesthesia during laryngoscopy. Those patients in whom the bronchoscope could be passed through the mouth and into the hypopharynx without topical anesthesia were classified as not having an intact gag reflex, while those requiring topical anesthesia (even in minimal amounts) were felt to have an intact gag reflex. At entry into the study, data were extracted from the patients’ charts regarding 13 baseline variables during the period of TLI. There were three continuous variables, age, serum albumin and serum creatinine; and nine dichotomous variables, blood pressure (systolic blood pressure less than 100 mm Hg for longer than one hour being defined as hypotension), medications (specifically the use or not of corticosteroids, antibiotics or vasoconstrictors), acidemia (arterial pH less than 7.35), hypoxemia (PaOa less than 55 mm Hg), hypercarbia (PaC02 greater than 45 mm Hg), position of translaryngeal tube (nasal vs oral), performance of a tracheostomy, oxygenation requirements (FIo2 greater than 50 percent for more than 12 hours being defined as hyperoxia) and neuromotor activity (inactivity defined as flaccid paralysis throughout the duration of TLI). read more
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01 Dec

Laryngeal Complications of Prolonged Intubation

Laryngeal Complications of Prolonged IntubationTranslaryngeal intubation is a commonly performed, frequently lifesaving procedure. It can be performed safely in an emergency situation and appears to be well tolerated for up to several days and possibly longer. However, TLI does cause complications, particularly in the larynx. Because the incidence, characteristics and contributing factors to TLI-induced laryngeal complications are still not well understood, we have prospectively studied both laryngeal pathology and clinically recognizable laryngeal adverse effects in a large series of patients undergoing TLI for more than four continuous days. Continue Reading »

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