Acute Laryngeal Injury: Risks, Outcomes, and Clinical Considerations

Today we are discussing acute laryngeal injury (ALgI).

Endotracheal intubation due to respiratory failure accounts for a large portion of intensive care unit admissions (Lowery et al., 2019). ALgI is a complication that occurs in over 50% of individuals following intubation and mechanical ventilation, which has the potential to evolve into stenosis, restricted glottic mobility, and ventilatory impairment (Davis et al., 2025; Lowery et al., 2019; Pagel et al., 2024). ALgI occurs at the mucosal interface of the endotracheal tube and the posterior larynx, and is associated with worse outcomes for breathing, voice, and swallowing (Davis et al., 2025; Lowery et al., 2019).

Risk factors for ALgI include endotracheal tube size, length of intubation, higher body mass index, lower height, tobacco use, and sex (Kavookjian et al., 2025; Pagel et al., 2024). Severity may be determined by laryngeal mucosal ulceration and/or grannulation tissue (Kavookjian et al., 2025). Individuals with ALgI may have lower rates of decannulation compared to those wtihout ALgI (Kavookjian et al., 2025; Pagel et al., 2024). Conservative treatment such as observation or medical management, may help support decannulation (Pagel et al., 2024). Direct laryngoscopy at the time of tracheostomy is necessary to determine the diagnosis of ALgI and to determine intervention options (Kavookjian et al., 2025).

Interested in learning more? Check out the references cited here.