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Published on: June 6, 2020
Risk factors for developing subglottic and tracheal stenosis from the medical intensive care unit
Robin B Pappal1, Clayton Prakash Burruss1, Michael A Witt1
1Department of Otolaryngology-Head and Neck Surgery University of Kentucky Lexington Kentucky USA.
Objective:
Endotracheal intubation is a common procedure in the medical intensive care unit (MICU), but it carries risk of complications including, but not limited to, subglottic stenosis (SGS) and tracheal stenosis (TS). Current literature suggests identifiable risk factors for the development of airway complications. This study is a comprehensive evaluation of potential risk factors in patients who developed SGS and TS following endotracheal intubation in our MICU.
Methods:
Patients intubated in our MICU were identified from 2013 to 2019. Diagnoses of SGS or TS within 1 year of MICU admission were identified. Data extracted included age, sex, body measurements, comorbidities, bronchoscopies, endotracheal tube size, tracheostomy, social history, and medications. Patients with prior diagnosis of airway complication, tracheostomy, or head and neck cancer were excluded. Univariate and multivariate logistic regressions were performed.
Results:
A total of 136 patients with TS or SGS were identified out of a sample of 6603 patients intubated in the MICU. Cases were matched to controls who did not develop airway stenosis based on identical Charlson Comorbidity Index scores. Eighty six controls were identified with a complete record of endotracheal/tracheostomy tube size, airway procedures, sociodemographic data, and medical diagnosis. Regression analysis showed that SGS or TS were associated with tracheostomy, bronchoscopy, chronic obstructive pulmonary disease, current tobacco use, gastroesophageal reflux disease, systemic lupus erythematosus, pneumonia, bronchitis, and numerous medication classes.
Conclusion:
Various conditions, procedures, and medications are associated with an increased risk of developing SGS or TS.
Level Of Evidence:
4.
Insights
Endotracheal intubation can lead to airway complications like subglottic stenosis (SGS) and tracheal stenosis (TS). Tracheostomy, bronchoscopy, COPD, and GERD are identified as significant risk factors for developing these conditions.
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.
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