Multiple Postintubation Complications

Four cases of multiple postintubation laryngotracheal injuries are presented. They encompass a range of injury including isolated soft tissue damage to total necrosis of the cricotracheal cartilages. The specific precursors were identified and retrospective pitfalls in management outlined. These included difficult intubation, an oversized endotracheal tube, a prolonged duration of intubation, reintubation, and debilitation. Three basic stages of injury were found upon which a treatment regimen was founded: 1) edema alone; 2) infected mucosa alone or with involvement of the internal perichondrium; and 3) true chondritis with or without necrosis. A rational, conservative management protocol based on these histopathological and clinical correlates was formulated.