Height is an independent risk factor for postintubation laryngeal injury

Laryngoscope. 2018 Dec;128(12):2811-2814. doi: 10.1002/lary.27237. Epub 2018 Oct 16.

Abstract

Objectives/hypothesis: Intubation is an essential component of intensive care, yet it does have potential complications. Posterior glottic stenosis (PGS) is among the most severe sequela. Risk factors are poorly understood. One hypothesis is that large endotracheal tubes (ETTs) in smaller airways may increase risk. Because tracheal diameter is proportional to height, we designed a case-control study to evaluate the association between intensive care unit (ICU)-patient height (proxy for tracheal diameter) and their risk of postintubation PGS.

Study design: Retrospective case-control study METHODS: Among patients who underwent intubation in an ICU at a single tertiary care medical center between 2001 and 2015, a convenience sample of all patients with confirmed PGS (cases) were enrolled. Cases were matched 1:1 by age, sex, and race with intubated non-PGS controls chosen from the same population of ventilated patients. Data on height, weight, comorbidities, size of ETT, and duration of intubation were abstracted from the medical record. Multivariate models were used to test the association between patient height and risk of PGS development.

Results: In all, 106 PGS cases (mean age 48.9 years, 50.7% female, 79.2% Caucasian) were identified; 77 met inclusion criteria. Compared to matched controls, cases were significantly shorter (mean 166 cm vs. 173 cm, P = .001). Height and PGS showed an inverse relationship in multivariate models. Specifically, odds of PGS decreased 9% (95% confidence interval: 0.01%-16%) for each centimeter increase in height.

Conclusions: Shorter height is independently associated with increased odds of having PGS. Further work should consider whether height should be incorporated into ETT selection algorithms.

Level of evidence: 3b Laryngoscope, 128:2811-2814, 2018.

Keywords: Laryngeal stenosis; intubation; posterior glottic stenosis.

MeSH terms

  • Body Height*
  • Case-Control Studies
  • Equipment Design
  • Female
  • Humans
  • Intubation, Intratracheal / adverse effects*
  • Laryngeal Diseases / etiology*
  • Laryngoscopes / adverse effects
  • Larynx / injuries*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors