by Brodsky, Martin B.;
Levy, Matthew J.; Jedlanek, Erin; Pandian, Vinciya; Blackford, Brendan; Price,
Carrie; Cole, Gai; Hillel, Alexander T.; Best, Simon R.; Akst, Lee M.
Objectives: To
systematically review the symptoms and types of laryngeal injuries resulting
from endotracheal intubation in mechanically ventilated patients in the ICU.
Data Sources:
PubMed, Embase, CINAHL, and Cochrane Library from database inception to
September 2017. Study Selection: Studies of adult patients who were
endotracheally intubated with mechanical ventilation in the ICU and completed
postextubation laryngeal examinations with either direct or indirect visualization.
Data Extraction:
Independent, double-data extraction and risk of bias assessment followed the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Risk of bias assessment followed the Cochrane Collaboration’s criteria.
Data Synthesis: Nine
studies (seven cohorts, two cross-sectional) representing 775 patients met
eligibility criteria. The mean (SD; 95% CI) duration of intubation was 8.2 days
(6.0 d; 7.7–8.7 d). A high prevalence (83%) of laryngeal injury was found. Many
of these were mild injuries, although moderate to severe injuries occurred in
13–31% of patients across studies. The most frequently occurring clinical
symptoms reported post extubation were dysphonia (76%), pain (76%), hoarseness
(63%), and dysphagia (49%) across studies.
Conclusions:
Laryngeal injury from intubation is common in the ICU setting. Guidelines for
laryngeal assessment and postextubation surveillance do not exist. A systematic
approach to more robust investigations could increase knowledge of the association
between particular injuries and corresponding functional impairments, improving
understanding of both time course and prognosis for resolution of injury. Our
findings identify targets for future research and highlight the long-known, but
understudied, clinical outcomes from endotracheal intubation with mechanical
ventilation in ICU.
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