Prolonged Intubation Injuries of the Larynx: Endoscopic Diagnosis, Classification, And Treatment

Area of Science:

• Otolaryngology
• Critical Care Medicine
• Pathology

Background:

• Prolonged endotracheal intubation is a common procedure in critical care settings.
• Laryngeal trauma is a known complication, ranging from superficial to severe injuries.
• Existing classifications may not fully capture the spectrum of severe, lasting laryngeal damage.

Purpose of the Study:

• To classify significant, severe, and lasting laryngeal trauma resulting from prolonged endotracheal intubation.
• To introduce new descriptive terminology for specific laryngeal injury patterns.
• To establish methods for precise injury assessment during intubation to guide clinical decisions.

Main Methods:

• Classification based on pathogenetic factors, direct laryngoscopy observations, and photographic documentation.
• Introduction of novel descriptive terms: "tongues of granulation tissue," "ulcerated troughs," "healed furrows," and "healed fibrous nodule."
• Use of telescopes with image magnification under general anesthesia for precise injury assessment during intubation.

Main Results:

• A new classification system for severe laryngeal trauma has been developed.
• Specific terminology aids in describing and understanding injury patterns.
• Magnified visualization during intubation allows for accurate assessment of injury severity.

Conclusions:

• Accurate assessment of laryngeal trauma during intubation is crucial for patient outcomes.
• The proposed classification and terminology enhance understanding of severe laryngeal injuries.
• Decisions regarding continued intubation versus tracheotomy can be optimized to minimize long-term morbidity.