Eur Arch Otorhinolaryngol (1997) 254 (Suppl. 1) : $97-S100 9 Springer-Verlag 1997 J. Vila. M. D. Bosque 9M. Garcia 9 M. Palomar P. Quesada - B. Ramis Endoscopic evolution of laryngeal injuries caused by translaryngeal intubation Abstract Despite improvements in tube design and ma- terials, the longer survival rates of critically ill patients make laryngeal and tracheal lesions still common follow- ing prolonged translaryngeal intubation. The time of intu- bation is almost the only factor employed in deciding whether or not tracheotomy has to be performed. Some patients will not develop laryngeal lesions afer long intu- bation periods, whereas some already have clinical symp- toms after short periods of time. If the conditions of the larynx and trachea could be assessed before irreversible complications take place, then timing of tracheotomy could be individualized to avoid laryngeal stenosis as well as unnecessary tracheostomies. We present the prelimi- nary results of an endoscopic study of the early laryngeal changes that take place during translaryngeal intubation. The method of exploration is explained and tissue changes seen and their evolution after extubation are de- scribed, emphasizing those that could have a predictive value. Key words Prolonged intubation 9 Laryngeal lesions 9 Tracheal lesions - Diagnostic endoscopy Introduction Although materials used in translaryngeal tubes have be- come more biocompatible, the increased incidence of mo- tor vehicle accidents together with the higher rates of sur- vival achieved by modem intensive care units (ICUs) can explain why lesions related to long-term intubation are J. Vila - P. Quesada 9 M. Garcfa - B. Ramis Department of Otorhinolaryngology, Hospital Universitario Vall d'Hebron, Barcelona, Spain M. D. Bosque - M. Palomar Department of Intensive Care Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain J. Vila Martfn (~) C/Bar6 de la Barre, 38, 2~ a, E-08023 Barcelona, Spain still common. Endotracheal intubation is a major cause of laryngeal and tracheal stenosis [1-6]. The incidence of la- ryngeal complications after long-term intubation has been evaluated in different studies, with various results [4, 9, 10, 11, 13]. Donnelly [4] demonstrated in 1969 that the first signs of endolaryngeal lesion could be seen after 3 h of intuba- tion, and that deep ulcerations could be present after 48 h. If the beginning of tissue changes is so early, some alter- ations could be seen in the intubated larynx before it is too late to prevent serious complications. Magnification pro- duced by endoscopes does not permit the microscopic ap- proach of a pathologist, but it gives a number of details that would otherwise be missed. It is generally accepted that the time of intubation is the most important single factor determining the develop- ment of the complications [8-10]. It is possible that laryn- geal problems could be significantly lessened if tra- cheotomy is done inmediately [8, 13] but surgery is also associated with complications [10]. Many studies have been done with groups of patients having different timing for tracheotomy in order to determine what would be the optimum moment to perform surgery. However, these do not say when each patient began to have lesions, and what was the evolution during intubation. If the conditons of the larynx and trachea could be assessed before irre- versible complications took place, then tracheotomy tim- ing could be better individualized and unnecessary surgery or its complications would be avoided. In order to be able to prevent lesions from intubation, we have designed a study in which early endoscopic eval- uation was performed at fixed intervals, so that early tis- sue changes could be recognized for their prognostic value. Materials and methods In May 1995 a protocol was established with the active participa- tion of the Departments of Otolaryngology and Intensive Care Medicine of the Hospital Universitario Vall d'Hebron, to study all the patients intubated for more than 24 h and admitted to a 32-bed