Eda ŞİMŞEK TANRIKULU, Ziya ŞİMŞEK, Eyüp Serhat ÇALIK, Fatih BİNGÖL, Ayşe ÇARLIOĞLU, Muhammed Recai MAZLUMOĞLU, Enise Armağan KOZA, Bilgehan ERKUT

Uzun süreli entübasyon yapılmış hastalarda laringofaringeal etkilerin değerlendirilmesi

Amaç,: Açık kardiyovasküler cerrahiler hem operasyon süresi hem de postoperatif yoğun bakımda takip süresi göz önüne alındığında entübasyon süresinin uzun olduğu bilinen ameliyatlardır. Biz bu çalışmada koroner cerrahisi sonrası uzun süre entübe kalmış hastalarda postoperatif dönemde gözlenen laringeal ve faringeal etkilenmeyi incelemek ve bu etkilerin oluşumuna zemin hazırlayan olası nedenleri araştırmayı amaçladık. Materyal ve Metodlar: Çalışmaya kardiyovasküler cerrahi yapılan toplam 42 hasta dahil edildi. Tüm hastalar preoperatif (preop) dönemde ve postoperatif dönemde (ortalama 7.gün) endoskopik muayene edildi ve muayene bulguları kaydedildi. Bulgular: Hastalar ortalama 61±9.98 yaşında, ortalama entübe kalma süresi 14.80±3.41saat, kullanılan entübasyon tüpünün iç çapı 8.02±0.4 mm idi. Preoperatif sigara içen hasta sayısı 25 (%59.52) ve preoperatif gastroözofageal reflü semptomu olan hasta sayısı 8 (% 19.04 ). Postoperatiflaringeal ve faringeal patolojik bulgu oranı %38.09 bulundu. Postoperatif laringeal ve faringeal patolojik bulgu olan hastalarda yaş, entübasyon süresi, preoperatif gastroözofageal reflü hastalığı şikayeti arasındaki ilişki isitatiksel açıdan anlamlı bulundu (p˂0,05).Ancak postoperatif patolojik bulgu ile cinsiyet, entübasyon tüpünün tipi ve çapı, sigara kullanma arasında anlamlı ilişki bulunmadı. Sonuç: Yaş, gastroözofageal reflü hastalığı varlığı, entübasyon süresinin uzunluğu postoperatif laringofaringeal bulgu oluşumu için risk faktörü olarak tespit edildi.

Anahtar Kelimeler:

Endotrakeal entübasyon, larinks, farinks, koroner cerrahi

Evaluation of laryngopharyngeal effects in patients long-term intubated

Aim: Open cardiovascular surgery involves prolonged intubation, postoperatively in the intensive care unit monitoring. The purpose of this study was to investigate the effects of long-term intubation after coronary artery surgery on laryngeal and pharyngeal structures and the probable underlying causes for such effects.Material and Methods: Forty two patients undergoing cardiovascular surgery were included in the study. All patients underwent endoscopic examination in the preoperative period and approximately 7th postoperative day. Results: Mean age of the patients was 61±9.98 years, mean duration of intubation was 14.80±3.41 hours (h) and mean size of intubation tube used was 8.02±0.45 mm. The number of preoperative smokers was 25(59.52%), and number of patients with preoperative gastroesophageal reflux disease symptoms were 8(19.04%). The level of postoperative laryngeal and pharyngeal pathological findings were 38.09%. Postoperative laryngeal and pharyngeal pathological findings were correlated with age, length of intubation and preoperative presence of the gastroesophageal reflux disease symptoms (p˂0.05). However, no statistically significant correlation was determined between postoperative pathological finding and sex, tube type, tube diameter, smoking status. Conclusion: Age, presence of gastroesophageal reflux disease, length of intubation were identified as risk factors for the development of postoperative pathological laryngopharyngeal findings.

Keywords:

Endotracheal intubation, larynx, pharynx, coronary surgery,

PDF

___

1. Skoretz SA, Yau TM, Ivanov J, Granton JT, Martino R. Dysphagia and Associated Risk Factors Following Extubation in CardiovascularSurgical Patients. Dysphagia 2014; 29: 647–54
2. House JC, Noordzij PJ, Murgia B, Langmore S. Laryngeal Injury From Prolonged Intubation: A Prospective Analysis of Contributing Factors. Laryngoscope 2011; 121: 596–600.
3. Mendels EJ, Brunings JW, Hamaekers AW, Stokroos RJ, Kremer B, BaijensLW. Adverse Laryngeal Effects Following Short-term General Anesthesia A SystematicReview. Arch Otolaryngol Head Neck Surg 2012; 138: 257-64
4. Mota LA, Cavalho GB, Brito VA. Laryngeal complications by orotracheal intubation: Literaturereview .Int. Arch. Otorhinolaryngol 2012; 16: 236-45.
5. Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, Buder TF. Laryngeal Morbidity and Quality of Tracheal Intubation A Randomized Controlled Trial. Anesthesiology 2003; 98: 1049–56
6. Bouabdallaoui N, Stevens SR, Doenst T et al. Impact of Intubation Time on Survival following Coronary Artery Bypass Grafting: Insights from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial.J Cardiothorac Vasc Anesth 2017; 23: 31030-33.
7. Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reﬂux symptom index (RSI). J Voice 2001; 16: 27–47
8. Su H. et al. Tongue Weakness and Somatosensory Disturbance Following Oral Endotracheal Extubation. Dysphagia 2015; 30: 188–95
9. Hamdana AL, Moukarbela RV, Farhata F, Obeidb M. Vocal cord paralysis after open-heart surgery. Eur J Cardiothorac Surg 2002; 21: 671–74
10. Yuan SM. Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: Theso-callediatrogenic Ortner’s (cardiovocal) syndrome revıew artıcle. Cardiology Journal 2012; 19: 560–66.
11. Rangachari V, Sundararajan I, SumathiV, Kumar KK. Laryngeal sequelae following prolonged intubation: A prospectivestudy. Indian J Crit Care Med 2006; 10: 171-75
12. Azarfarin R, Ashouri N, Totonchi Z, Bakhshandeh H, Yaghoubi AR. Factors Influencing Prolonged ICU Stay After Open Heart Surgery. Res Cardiovasc Med 2014; 3: 20159
13. Silva CE, Niedermeier BT, Portinho F. Reﬂux Laryngitis: Correlation between the Symptoms Findings and Indirect Laryngoscopy. Int Arch Otorhinolaryngol 2015; 19: 234–37.
14. Martinucci I et al. Optimal treatment of laryngopharyngeal reflux disease. Ther Adv Chronic Dis 2013; 4: 287 –301
15. Bain WM, Harrington JW, Thomas LE, Schaefer SD. Head and neck manifestations of gastroesophageal reflux. Laryngoscope 1983; 93: 175-79.
16. Johnson KN, Botros DB, Groban L, Bryan YF. Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management. Clinical Interventions in Aging 2015; 10: 1925–34.
17.Branski RC, Zhou H, KrausDH, Sivasankar M. The Effects of Cigarette Smoke Condensate on Vocal Fold Transepithelial Resistance and Inflammatory Signaling in Vocal Fold Fibroblasts. Laryngoscope 2011; 121: 601–05
18. Geraci G, Cupido F, LoNigro C, Sciuto A,Sciumè C,Modica G. Postoperative laryngeal symptoms in a general surgery setting. Clinical study. Ann Ital Chir 2013; 84: 377-78