Intubation-related tracheal ischemic lesions: incidence, risk factors, and outcome

Intensive Care Med. 2013 Apr;39(4):575-82. doi: 10.1007/s00134-012-2750-6. Epub 2012 Nov 16.


Purpose: To determine incidence, risk factors and outcome of tracheal ischemic lesions related to intubation.

Methods: Planned post hoc analysis using patients from a previous randomized controlled study. Fiberoptic tracheoscopy was performed during the 24 h following extubation. In patients with >2 ischemic lesions, ulcer or tracheal rupture, fiberoptic tracheoscopy was repeated 2 weeks after the last extubation. Tracheal ischemic lesions were predefined based on a quantitative score.

Results: Ninety-six adult patients were included in this study. Eighty (83 %) patients had at least one tracheal ischemic lesion. Thirty-seven (38 %) patients had a tracheal ischemia score > median score (5; IQ 1, 7). The most common tracheal ischemic lesion was ischemia (68 %), followed by hyperemia (54 %), ulcer (10 %), and tracheal rupture (1 %). Univariate analysis identified duration of neuromuscular-blocking agent use, overinflation of tracheal cuff (>30 cmH2O), percentage of P cuff determination >30 cmH2O, duration of assist-control ventilation, and plateau pressure as risk factors for having a tracheal ischemia score >5. Duration of assist-control mechanical ventilation was the only factor independently associated with tracheal ischemia score >5 [OR (95 % CI) 1.10 per hour (1.02-1.20)]. A fiberoptic tracheoscopy was performed 2 weeks after extubation in 22 patients. This examination was normal in all patients, except the one with tracheal rupture who had marked improvement.

Conclusion: Tracheal ischemic lesions are common in intubated, critically ill patients. Duration of assist-control mechanical ventilation through a tracheal tube is the only independent risk factor. These lesions healed in the majority of patients 2 weeks after extubation.

MeSH terms

  • Aged
  • Analysis of Variance
  • Endoscopy / methods
  • Female
  • Fiber Optic Technology
  • Follow-Up Studies
  • Humans
  • Incidence
  • Intubation, Intratracheal / adverse effects*
  • Intubation, Intratracheal / methods
  • Intubation, Intratracheal / statistics & numerical data
  • Ischemia / complications
  • Ischemia / epidemiology
  • Ischemia / etiology*
  • Male
  • Middle Aged
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Severity of Illness Index
  • Tracheal Diseases / diagnosis
  • Tracheal Diseases / epidemiology
  • Tracheal Diseases / etiology*
  • Treatment Outcome