Predictors of Posterior Glottic Stenosis: A Multi-Institutional Case-Control Study

Area of Science:

• Critical Care Medicine
• Otolaryngology
• Medical Device Research

Background:

• Posterior glottic stenosis (PGS) is a serious complication following tracheal intubation.
• Identifying modifiable risk factors is crucial for preventing PGS and improving patient outcomes in intensive care units (ICUs).

Purpose of the Study:

• To identify intrinsic and extrinsic risk factors associated with the development of posterior glottic stenosis (PGS) in intubated patients.
• To evaluate the association between endotracheal tube (ETT) size and PGS development.

Main Methods:

• Retrospective case-control study comparing 28 PGS patients with 112 control patients.
• Data collected included patient demographics, comorbidities, intubation duration, ETT size, and indication for intubation.
• Multivariate analysis was used to identify significant risk factors.

Main Results:

• Ischemia, diabetes mellitus, and longer intubation duration were significant risk factors for PGS.
• Males intubated with ETT size 8 or larger had a higher incidence of PGS compared to controls (100% vs. 72.3%).
• PGS, intubation length, and obstructive sleep apnea were risk factors for requiring tracheostomy.

Conclusions:

• Significant risk factors for PGS include intubation duration, ischemia, diabetes mellitus, and large ETT size (≥8) in males.
• Reducing the use of large ETTs and considering earlier tracheostomy in high-risk individuals may decrease PGS incidence.
• These findings can inform strategies to enhance ICU safety and prevent airway complications.