Laryngeal Injury and Upper Airway Symptoms After Endotracheal Intubation During Surgery: A Systematic Review and Meta-analysis.
Laryngeal Injury and Upper Airway Symptoms After Endotracheal Intubation During Surgery: A Systematic Review and Meta-analysis.
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DOI：
10.1213/ane.0000000000005276
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发表时间：
2021-04-01
影响因子：
5.7
通讯作者：
Levy MJ
中科院分区：
文献类型：
--
作者：
Brodsky MB;Akst LM;Jedlanek E;Pandian V;Blackford B;Price C;Cole G;Mendez-Tellez PA;Hillel AT;Best SR;Levy MJ
插管引起的喉部损伤会严重影响呼吸道、嗓音和吞咽，因此需要多学科的干预。这项系统性综述的目标是：(1)回顾喉部损伤的类型及其患者报告的症状和临床体征；(2)更好地了解喉部损伤的总体情况，以及这些损伤发生的频率。我们检索了4个在线书目数据库(即PubMed、Embase、护理和相关卫生文献累积索引(CINAHL)和Cochrane图书馆)以及ProQuest和开放获取论文(OPTD)，从数据库建立到2019年9月，没有语言限制。这些研究包括完成气管插管手术的成人患者拔管后喉部可视化检查的研究。我们排除了：1)回顾性研究，2)病例研究，3)既往存在的喉部损伤/疾病，4)有喉返神经损伤病史或手术治疗的患者，5)会议摘要，以及6)非局限性神经损伤可能影响嗓音和吞咽功能的患者群体，从而使识别孤立的拔管后喉部损伤变得困难。独立、双重数据提取和偏倚风险评估遵循系统回顾和荟萃分析(PRISMA)指南和Cochrane协作标准的首选报告项目。21篇文章(1篇横断面研究，3个队列，5个病例系列，12个随机对照试验)代表了21个外科研究，包括6140名患者，符合资格标准。所有研究报告的患者平均年龄为49岁(95%可信区间：45，53)，平均插管时间为132分钟(95%可信区间：106,159)。研究报告80%(95%可信区间：69%，88%)的患者没有受伤。所有21项研究都是关于损伤类型的。水肿是最常见的轻度损伤，患病率为9%-84%。声带血肿是最常见的中度损伤，患病率为4%(95%可信区间：2%，10%)。严重的损伤，包括颧骨半脱位和声带瘫痪是罕见的(<；1%)结果。拔管后最常见的患者主诉是吞咽困难(43%)、疼痛(38%)、咳嗽(32%)、喉咙痛(27%)和声音嘶哑(27%)。总体而言，短期手术插管引起的喉部损伤是常见的，而且通常是轻微的。手术拔管后的喉部评估没有统一的指南，声音嘶哑也不是喉部损伤或吞咽困难的良好指标。对拔管后的发音困难和吞咽困难进行程序化筛查可能会改善对损伤的识别，从而改善患者的预后并降低医疗保健利用率。
Laryngeal injury from intubation can substantially impact airway, voice, and swallowing, thus necessitating multidisciplinary interventions. The goals of this systematic review were: (1) to review the types of laryngeal injuries and their patient-reported symptoms and clinical signs resulting from endotracheal intubation in patients intubated for surgeries and (2) to better understand the overall the frequency at which these injuries occur. We conducted a search of 4 online bibliographic databases (i.e., PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and The Cochrane Library) and ProQuest and Open Access Thesis Dissertations (OPTD) from database inception to September 2019 without restrictions for language. Studies that completed post-extubation laryngeal examinations with visualization in adult patients who were endotracheally intubated for surgeries were included. We excluded: 1) retrospective studies, 2) case studies, 3) pre-existing laryngeal injury/disease, 4) patients with histories of or surgical interventions that risk injury to the recurrent laryngeal nerve, 5) conference abstracts, and 6) patient populations with non-focal, neurological impairments that may impact voice and swallowing function, thus making it difficult to identify isolated post-extubation laryngeal injury. Independent, double-data extraction, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Collaboration’s criteria. Twenty-one articles (1 cross-sectional, 3 cohort, 5 case series, 12 randomized controlled trials) representing 21 surgical studies containing 6140 patients met eligibility criteria. The mean patient age across studies reporting age was 49 (95%CI: 45, 53) years with a mean intubation duration of 132 (95%CI: 106, 159) minutes. Studies reported no injuries in 80% (95%CI: 69%, 88%) of patients. All 21 studies presented on type of injury. Edema was the most frequently reported mild injury, with a prevalence of 9-84%. Vocal fold hematomas were the most frequently reported moderate injury, with a prevalence of 4% (95%CI: 2%, 10%). Severe injuries that include subluxation of the arytenoids and vocal fold paralysis are rare (<1%) outcomes. The most prevalent patient complaints post-extubation were dysphagia (43%), pain (38%), coughing (32%), a sore throat (27%), and hoarseness (27%). Overall, laryngeal injury from short-duration surgical intubation is common and is most often mild. No uniform guidelines for laryngeal assessment post-extubation from surgery are available and hoarseness is neither a good indicator of laryngeal injury or dysphagia. Protocolized screening for dysphonia and dysphagia post-extubation may lead to improved identification of injury and, therefore, improved patient outcomes and reduced healthcare utilization.