VIDEOLARYNGOSCOPY AFTER ENDOTRACHEAL INTUBATION .2. A CRITICAL CARE PERSPECTIVE OF LESIONS AFFECTING VOICE

In a Critical Care setting, videolaryngoscopic techniques document nearly universal vocal fold lesions in patients after endotracheal intubation. A miniaturized, moderately priced, transportable system, utilizing rigid and flexible fiberoptic laryngoscopes, coupled with a compact 8-mm camcorder, is featured. Laryngeal damage begins within 1 h of placement of an endotracheal tube. Posterior erosions at the level of the vocal processes appear within 24 h, characteristic "key-hole" lesions in the posterior glottis appear within 48 h, granulations are seen within 72 h, and granulomatous polyps occur by 144 h after endotracheal intubation. Nasogastric intubation promotes gastroesophageal reflux laryngitis. Acute dysphonia, permanent voice problems, and airway obstruction occur with greater frequency than previously suspected. Early tracheostomy, within 6 days of endotracheal intubation, appears to prevent permanent vocal fold damage and provides comfortable, effective airways toilette. © 1990 Raven Press, Ltd., New York.