The following is a summary of the “Optimal Tracheostomy Timing Through Modeling Based on Severity of Vocal Cord Injury,” published in the February 2023 issue of Respiratory Care by Malkoc, et al.

In the intensive care unit, intubation through the trachea is common. Despite the known risks of laryngeal and tracheal injury from endotracheal intubation, this study looked at other variables that might impact the development of posterior vocal cord ulcers (PVCUs).

Around 1,355 patients who had a tracheostomy with routine bronchoscopy at a single institution between 2002 and 2018 were retrospectively screened. Notes are written after a tracheostomy were considered for inclusion only if they revealed information about the viability of the vocal cords. 

The primary outcome measures were the presence of PVCU, the duration of mechanical ventilation before tracheostomy, the length of hospital stay, and mortality. Using analysis of variance, multivariate analysis, and Kaplan-Meier modeling of PVCU incidence over time, the data were stratified according to ulcer severity (mild, moderate, and severe). They enrolled 192 people who had visual evidence of their vocal cords. Only 39 subjects had a PVCU, while the remaining 153 did. Mild PVCU was seen in those intubated for a median of 9 (IQR 5-13) days, while those intubated for a median of 6 (IQR 4-7) days did not develop an ulcer. 

There was a statistically significant (P< .001) correlation between the duration of ventilation support before tracheostomy and the degree of PVCU severity. After 2 weeks of endotracheal intubation, the Kaplan-Meier model found that the risk of developing a moderate vocal cord ulcer increased to > 80%. On day 7, however, the likelihood of even a mild ulcer has dropped to 20%. According to the Kaplan-Meier analysis, the morbidity of posterior vocal cord injury may be reduced if a tracheostomy is placed within a week of the injury rather than 14 days later.

Source: rc.rcjournal.com/content/68/2/255