Abstract：
BACKGROUND: Iatrogenic injury to the larynx, particularly the vocal cords from prolonged intubation, has been well-studied; however, tracheal injuries are rarely reported. This study investigates the effectiveness of cuffed, high-volume, low-pressure endotracheal tubes in preventing the development of tracheal ulcers in intubated subjects.
METHODS: A retrospective, IRB-approved review was performed on 1355 subjects who underwent percutaneous tracheostomy from 2002 to 2018. The presence and severity of tracheal ulcers were collected using documentation and photos during percutaneous tracheostomy placement. Primary outcome measures included: the length of time on a ventilator until tracheostomy (LOVT), length of hospitalization (LOH), and mortality in relationship to the severity of the tracheal injury. Data was reported as n (%) and median (IQR). The differences in means between groups were analyzed by ANOVA and Chi-square test with an alpha of 0.05.
RESULTS: 206 subjects met the inclusion criteria; 65 subjects had an absence of tracheal injury, and 141 subjects developed tracheal ulcers. Subjects with tracheal ulcers were grouped by the following severity scale: no ulcer; mild ulcer (minimal mucosal erosion with exudate); moderate ulcer (mucosal erosion); and severe (tracheal ring exposure). There were no statistically significant differences in age (p = 0.99), gender (p = 0.83), BMI (p = 0.44), LOH (p = 0.88), LOVT (p = 0.93), and mortality (p = 0.306) between subjects with differing severity of ulcers. The average annual incidence of clinically significant ulcers (moderate and severe) was 2.2 %.
CONCLUSIONS: The lack of statistical correlation between the duration of intubation and tracheal ulcer severity, along with a low annual incidence of tracheal ulcers, supports the improved safety of high-volume, low-pressure cylindrical, cuffed endotracheal tubes. This study is among the first to specifically focus on injuries at the level of the cuff and tip of endotracheal tubes with implications in preventive measures and potential product design changes.
METHODS: A retrospective, IRB-approved review was performed on 1355 subjects who underwent percutaneous tracheostomy from 2002 to 2018. The presence and severity of tracheal ulcers were collected using documentation and photos during percutaneous tracheostomy placement. Primary outcome measures included: the length of time on a ventilator until tracheostomy (LOVT), length of hospitalization (LOH), and mortality in relationship to the severity of the tracheal injury. Data was reported as n (%) and median (IQR). The differences in means between groups were analyzed by ANOVA and Chi-square test with an alpha of 0.05.
RESULTS: 206 subjects met the inclusion criteria; 65 subjects had an absence of tracheal injury, and 141 subjects developed tracheal ulcers. Subjects with tracheal ulcers were grouped by the following severity scale: no ulcer; mild ulcer (minimal mucosal erosion with exudate); moderate ulcer (mucosal erosion); and severe (tracheal ring exposure). There were no statistically significant differences in age (p = 0.99), gender (p = 0.83), BMI (p = 0.44), LOH (p = 0.88), LOVT (p = 0.93), and mortality (p = 0.306) between subjects with differing severity of ulcers. The average annual incidence of clinically significant ulcers (moderate and severe) was 2.2 %.
CONCLUSIONS: The lack of statistical correlation between the duration of intubation and tracheal ulcer severity, along with a low annual incidence of tracheal ulcers, supports the improved safety of high-volume, low-pressure cylindrical, cuffed endotracheal tubes. This study is among the first to specifically focus on injuries at the level of the cuff and tip of endotracheal tubes with implications in preventive measures and potential product design changes.
摘要：
背景：喉的医源性损伤，特别是长时间插管的声带，已经被充分研究；然而，气管损伤很少报道。这项研究调查了袖口的有效性，高容量，低压气管内导管预防气管溃疡的发展。
方法：回顾性研究，IRB批准的审查是对2002年至2018年接受经皮气管切开术的1355名受试者进行的。在经皮气管造口术放置期间，使用文件和照片收集了气管溃疡的存在和严重程度。主要结局指标包括：使用呼吸机直到气管造口术（LOVT）的时间长度，住院时间（LOH），和死亡率与气管损伤的严重程度有关。数据报告为n(%)和中位数(IQR)。通过ANOVA和卡方检验(α为0.05)分析组间均值的差异。
结果：206名受试者符合纳入标准；65名受试者没有气管损伤，141名受试者出现了气管溃疡。根据以下严重程度对气管溃疡的受试者进行分组：无溃疡；轻度溃疡（有渗出液的粘膜糜烂）；中度溃疡（粘膜糜烂）；和严重（气管环暴露）。年龄差异无统计学意义（p=0.99），性别（p=0.83），BMI（p=0.44），LOH（p=0.88），LOVT（p=0.93），和死亡率（p=0.306）之间的受试者有不同的溃疡严重程度。临床显着溃疡（中度和重度）的平均年发病率为2.2％。
结论：插管时间与气管溃疡严重程度之间缺乏统计学相关性，伴随着气管溃疡的低年发病率，支持提高高容量的安全性，低压圆柱形,袖口气管导管.这项研究是第一个专门针对气管导管袖带和尖端水平的损伤的研究，这些损伤对预防措施和潜在的产品设计变化具有影响。
方法：回顾性研究，IRB批准的审查是对2002年至2018年接受经皮气管切开术的1355名受试者进行的。在经皮气管造口术放置期间，使用文件和照片收集了气管溃疡的存在和严重程度。主要结局指标包括：使用呼吸机直到气管造口术（LOVT）的时间长度，住院时间（LOH），和死亡率与气管损伤的严重程度有关。数据报告为n(%)和中位数(IQR)。通过ANOVA和卡方检验(α为0.05)分析组间均值的差异。
结果：206名受试者符合纳入标准；65名受试者没有气管损伤，141名受试者出现了气管溃疡。根据以下严重程度对气管溃疡的受试者进行分组：无溃疡；轻度溃疡（有渗出液的粘膜糜烂）；中度溃疡（粘膜糜烂）；和严重（气管环暴露）。年龄差异无统计学意义（p=0.99），性别（p=0.83），BMI（p=0.44），LOH（p=0.88），LOVT（p=0.93），和死亡率（p=0.306）之间的受试者有不同的溃疡严重程度。临床显着溃疡（中度和重度）的平均年发病率为2.2％。
结论：插管时间与气管溃疡严重程度之间缺乏统计学相关性，伴随着气管溃疡的低年发病率，支持提高高容量的安全性，低压圆柱形,袖口气管导管.这项研究是第一个专门针对气管导管袖带和尖端水平的损伤的研究，这些损伤对预防措施和潜在的产品设计变化具有影响。
