Laryngeal Injury After Prone Positioning: A Cadaveric Evaluation of Endotracheal Contact Pressures

Laryngotracheal stenosis (LTS) has been described as a complication of prolonged intubation. Early in the COVID‐19 pandemic, many patients were intubated and ventilated for a long period, often in the prone position. To investigate the physical effects of prone versus supine positioning and its possible correlation to LTS, this research used two Thiel‐embalmed cadavers, one male and one female, and a novel pressure sensor device, to directly measure the force applied by an endotracheal tube onto the posterior glottis. The male cadaver's mean posterior glottic force was 388 g supine (range 200‐885 g) and 662 g prone (range 398‐892 g) ( P < .001). The female cadaver's mean posterior glottic pressure was 586 g supine (range 202‐1794 g) and 1659 g prone (range 944‐2183 g) ( P < .001). Both cadavers experienced a significantly higher posterior glottic pressure in the prone position, with a higher increase in the female cadaver compared to the male cadaver.