Association of Severe Tongue Edema With Prone Positioning in Patients Intubated for COVID-19.
Citation: Laryngoscope. 132(2):287-289, 2022 02.PMID: 34287907Institution: MedStar Washington Hospital CenterDepartment: Otolaryngology | Otolaryngology ResidencyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *COVID-19/co [Complications] | *Glossitis/et [Etiology] | *Intubation, Intratracheal/ae [Adverse Effects] | *Patient Positioning/ae [Adverse Effects] | *Prone Position | Adult | Aged | Aged, 80 and over | Female | Humans | Male | Middle Aged | Respiration, Artificial/ae [Adverse Effects] | Respiratory Insufficiency/th [Therapy] | Respiratory Insufficiency/vi [Virology] | Retrospective Studies | Risk Factors | SARS-CoV-2 | Tongue/pa [Pathology]Year: 2022Local holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library: 1996 - 2003Abstract: CONCLUSION: Tongue edema appears to develop in a subset of patients with COVID-19 who are intubated. It appears to be associated with prone positioning but is likely multifactorial in nature. Further investigation into its incidence and pathophysiology is warranted. This article is protected by copyright. All rights reserved. Copyright This article is protected by copyright. All rights reserved.METHODS: A single-system retrospective cohort study of patients intubated for respiratory failure secondary to COVID-19 who subsequently developed clinically notable tongue edema from March 13 to July 5, 2020.OBJECTIVE: Prone positioning is frequently used in patients intubated for COVID-19 related lung injury to improve oxygenation. At our institution, we observed severe tongue edema develop in some of these patients. Hence, we sought to determine the incidence of tongue edema in this cohort and whether prone positioning was a risk factor associated with this complication.RESULTS: 260 patients were intubated for COVID-19 related respiratory failure during the study period. 158 patients (60.8%) underwent at least one episode of proning. 12 patients in total (4.6%) developed clinically significant tongue edema. 11 of the 12 patients (91.7%) who developed tongue edema underwent proning prior to the development of edema. Prone positioning was associated with an increased incidence of tongue edema (odds ratio [OR] 7.56, 95% confidence interval [CI] 0.96-59.46, p = 0.027). In all proned patients who developed edema, this complication was noted during proning or shortly after supination (range 0-4 days). Tongue edema was primarily managed with conservative measures; one patient required tracheostomy for definitive management.Originally published: Laryngoscope. 2021 Jul 20Fiscal year: FY2022Fiscal year of original publication: FY2022Digital Object Identifier: ORCID:- Gao, William Z Parsa, Keon Shearer, Sarah Walsh, Amanda:
- https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 Gao, William Z Parsa, Keon Shearer, Sarah Walsh, Amanda:
- https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 Gao, William Z Parsa, Keon Shearer, Sarah Walsh, Amanda:
- https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 Gao, William Z Parsa, Keon Shearer, Sarah Walsh, Amanda:
- https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404 https://orcid.org/0000-0002-5382-9440 https://orcid.org/0000-0001-9198-5121 https://orcid.org/0000-0002-2851-2126 https://orcid.org/0000-0001-7703-2404
| Item type | Current library | Collection | Call number | Status | Date due | Barcode |
|---|---|---|---|---|---|---|
| Journal Article | MedStar Authors Catalog | Article | 34287907 | Available | 34287907 |
Available online from MWHC library: 1997 - present, Available in print through MWHC library: 1996 - 2003
CONCLUSION: Tongue edema appears to develop in a subset of patients with COVID-19 who are intubated. It appears to be associated with prone positioning but is likely multifactorial in nature. Further investigation into its incidence and pathophysiology is warranted. This article is protected by copyright. All rights reserved. Copyright This article is protected by copyright. All rights reserved.
METHODS: A single-system retrospective cohort study of patients intubated for respiratory failure secondary to COVID-19 who subsequently developed clinically notable tongue edema from March 13 to July 5, 2020.
OBJECTIVE: Prone positioning is frequently used in patients intubated for COVID-19 related lung injury to improve oxygenation. At our institution, we observed severe tongue edema develop in some of these patients. Hence, we sought to determine the incidence of tongue edema in this cohort and whether prone positioning was a risk factor associated with this complication.
RESULTS: 260 patients were intubated for COVID-19 related respiratory failure during the study period. 158 patients (60.8%) underwent at least one episode of proning. 12 patients in total (4.6%) developed clinically significant tongue edema. 11 of the 12 patients (91.7%) who developed tongue edema underwent proning prior to the development of edema. Prone positioning was associated with an increased incidence of tongue edema (odds ratio [OR] 7.56, 95% confidence interval [CI] 0.96-59.46, p = 0.027). In all proned patients who developed edema, this complication was noted during proning or shortly after supination (range 0-4 days). Tongue edema was primarily managed with conservative measures; one patient required tracheostomy for definitive management.
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