Laryngeal complications by orotracheal intubation: literature review

Int. Arch. Otorhinolaryngol. 2012;16(2):236-245. DOI: 10.7162/S1809-97772012000200014 Review Article Laryngeal complications by orotracheal intubation: Literature review Complicações laringeas por intubação orotraqueal: Revisão da literatura Luiz Alberto Alves Mota1, Glauber Barbosa de Cavalho2, Valeska Almeida Brito2. 1) Master in Surgery for the Federal University of Pernambuco. Professor Assistant of Otolaryngology of the College of Medical Sciences of the University of Pernambuco. 2) Graduating of Medicine of the College of Medical Sciences of the University of Pernambuco. Graduating of Medicine of the College of Medical Sciences of the University of Pernambuco. 3) Graduate Student of Medicine of the College of Medical Sciences of the University of Pernambuco. Graduate Student of Medicine of the College of Medical Sciences of the University of Pernambuco. Institution: College of Sciences Doctor - University de Pernambuco. Recife / PE - Brazil. Mailing address: Luiz Alberto Alves Mota - Venezuela Street, 182 - Espinheiro. Zip-code: 52020-170 - Recife - PE - Brazil - E-mail: Article received in July 22, 2010. Article approved in September 1, 2010. SUMAMRY RESUMO Introduction: The injuries caused for the orotracheal intubation are common in our way and widely told by literature. Generally the pipe rank of or consequence of its permanence in the aerial ways of the patient is caused by accidents in. It has diverse types of larynx injuries, caused for multiple mechanisms. Objective: To verify, in literature, the main causes of laryngeal complications after- orotracheal intubation and its mechanisms of injury. Revision of Literature: The searched databases had been LILACS, BIREME and SCIELO. Were updated, books and theses had been used, delimiting itself the period enters 1953 the 2009. The keywords used for the search of articles had been: complications, injuries, larynx, intubation, endotracheal, orotracheal, granulomas, stenosis. 59 references had been selected. The used criteria of inclusion for the choice of articles had been the ones that had shown to the diverse types of injuries caused for the orotracheal intubation and its pathophysiology. Final Considerations: This revision of literature was motivated by the comment in the practical clinic of a great number of laryngeal sequels in patients submitted to the orotracheal intubation. Of that is ahead important the knowledge, for the professionals of the area of health, the types of complications and its causes, with intention to prevent them, adopting measured of prevention of these injuries. Keyword: larynx, dysphonia, voice. Introdução: As lesões causadas pela intubação orotraqueal são comuns no nosso meio e amplamente relatadas pela literatura. Geralmente são causadas por acidentes na colocação do tubo ou consequência de sua permanência nas vias aéreas do paciente. Há diversos tipos de lesões laríngeas, causadas por múltiplos mecanismos. Objetivo: Verificar, na literatura, as principais causas de complicações laríngeas pós-intubação orotraqueal e seus mecanismos de lesão. Revisão de Literatura: As bases de dados pesquisadas foram LILACS, BIREME e SCIELO. Foram utilizados artigos, livros e teses, delimitando-se o período entre 1953 a 2009. As palavras-chaves utilizadas para a busca dos artigos foram: complicações, lesões, laringe, intubação, entubação, endotraqueal, orotraqueal, granulomas, estenose. Foram selecionadas 59 referências. Os critérios de inclusão utilizados para a escolha dos artigos foram os que mostraram os diversos tipos de lesões ocasionadas pela intubação orotraqueal e suas fisiopatologias. Considerações Finais: Esta revisão de literatura foi motivada pela observação na prática clínica de um grande número de sequelas laríngeas em pacientes submetidos à intubação orotraqueal. Diante disto é importante o conhecimento, pelos profissionais da área de saúde, dos tipos de complicações e de suas causas, com o intuito de evitá-las, adotando medidas de prevenção dessas lesões. Palavras-chave: laringe, disfonia, voz. Int. Arch. Otorhinolaryngol., São Paulo - Brazil, v.16, n.2, p. 236-245, Apr/May/June - 2012. 236 Laryngeal complications by orotracheal intubation: Literature review. Mota et al. INTRODUCTION denominator, particularly for the use of tracheal pipes of bigger diameter and for the raised intracuff pressure (7). The delicate structures of the larynx can be compromised by innumerable causes (1). One of them is the endotracheal intubation. The factors of risk for the endotracheal afterintubations complications are of three types: factors related to the patient, related with the requirements technician to reach and to keep the intubation, and factors related to medic (3). The endotracheal intubation allows to the ventilation assistance in anaesthetized patients or under ventilation mechanics, being able to be of shortness or long duration. The presence of pipes or nasotracheals in direct contact with the structures of the aerial ways can provoke injuries of mucus, derive from, mainly, of traumatic and drawn out intubations, the use of pipes of great bore and of the raised pressure in the ballonet of probes (2). The traumatic intubation can occur in emergency situations, that demand rapidity in the access of the aerial ways, in the difficult exposition of glottis or when carried through by professionals inexperienced (1,2). The complications of the secondary aerial ways to the endotracheal intubation are frequent, even so have diminished significantly in recent years. Many occur with light symptoms and of short duration. However, in many cases the injuries are serious and permanent, involving the structures of the larynx and the trachea, and demand surgery correction (2,3). The some complications have global incidence varying of 0% the 18% (4,5). Prospective study, it found index of 63% of acute injuries of the larynx in patients submitted to the orotracheal intubation and that they had been reversible in 30 days (6). Due to configuration of glottis in “V”, the main injuries occur in the posterior portion of the larynx, in the vocal processes, where the sounding lead meets in close contact with the mucous, being able to result in ulceration of the region that involves the epithelium of the interarytenoid mucous, healing with fibrosis and setting of the arytenoids cartilages in the median line, simulating picture of bilateral paralysis of the folds vocals (2). Diverse types of larynx and windpipes, secondary injuries to the endotracheal intubation, have been described (7). Soon in the introduction of the cannula for it verbal via, during the attempts of exposition of glottis with the laryngoscope, are described, extractions, injury of lip, language and pharynx vocal lacerations in epiglottis, folds, esophagus and trachea, hematomas and accession of vocal folds, displacement and strain of arytenoids cartilages (8). With the time complications occur as frostbite of mucous, stricture a (...truncated)