Risk factors for developing subglottic and tracheal stenosis from the medical intensive care unit

Area of Science:

• Medical Intensive Care
• Pulmonology
• Critical Care Medicine

Background:

• Endotracheal intubation is a frequent procedure in medical intensive care units (MICUs).
• This procedure carries risks, including subglottic stenosis (SGS) and tracheal stenosis (TS).
• Identifying risk factors is crucial for preventing airway complications.

Purpose of the Study:

• To comprehensively evaluate potential risk factors for SGS and TS in patients following endotracheal intubation.
• To analyze associations between various patient characteristics, procedures, and medications with airway stenosis development.

Main Methods:

• Retrospective analysis of 6603 patients intubated in the MICU from 2013-2019.
• Identification of 136 patients diagnosed with SGS or TS within one year of MICU admission.
• Logistic regression analysis comparing cases with matched controls, considering comorbidities, procedures, and medications.

Main Results:

• SGS or TS were associated with tracheostomy and bronchoscopy procedures.
• Chronic obstructive pulmonary disease (COPD), current tobacco use, and gastroesophageal reflux disease (GERD) were significant risk factors.
• Systemic lupus erythematosus, pneumonia, bronchitis, and specific medication classes also showed associations with airway stenosis.

Conclusions:

• Several conditions, procedures, and medications increase the risk of developing SGS and TS post-intubation.
• Understanding these risk factors can guide preventative strategies in critical care settings.