Shorter Height Associated with Higher Risk of Posterior Glottic Stenosis

by Amy E. Hamaker •

What is the association between intensive care unit (ICU)-patient height (as a proxy for tracheal diameter) and risk of postintubation posterior glottic stenosis (PGS)?

Bottom Line
Shorter height is independently associated with increased odds of having PGS, with the odds of developing PGS decreasing 9% for each centimeter increase in height.

Background: Intubation is an essential, largely safe component of intensive care, but it does have potential complications. PGS is insidious, debilitating, often irreversible, usually manifests well after hospital discharge, and can profoundly affect phonation, deglutition, and respiration. However, postintubation PGS risk factors remain poorly understood and largely unappreciated by practitioners providing acute care.

Study design: Retrospective case-control study of 77 PGS and 106 control patients who underwent intubation in an ICU at a single tertiary care medical center between 2001 and 2015.

Setting: Division of Pulmonary and Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville.

Synopsis: Compared to controls, PGS cases had a higher Charlson Comorbidity Index (CCI) and were significantly shorter. Cases and controls did not differ with respect to weight or in the average size of endotracheal tube (ETT) used. Intubation duration was not significantly longer in the PGS case group. Patient height was independently associated with PGS in multivariable models accounting for age, race, sex, weight, ETT size, and CCI. Specifically, odds of PGS decreased 9% for each centimeter increase in height; only weight and CCI were significantly associated with PGS. Increasing intubation duration was linearly associated with a higher probability of having PGS. Additionally, there was a modest age- and sex-adjusted correlation between height and size of the ETT used. There was no association between weight and ETT size. Limitations included use of somewhat lacking ICD-9 codes for identification, a lack of uniform evaluation of PGS severity, and a possible underestimation of postintubation PGS frequency.

Citation: Katsantonis NG, Kabagambe EK, Wootten CT, et al. Height is an independent risk factor for postintubation laryngeal injury. Laryngoscope. Published online ahead of print October 16, 2018. doi: 10.1002/lary. 27237.