Rapid Tracheal Injury by Cuffed Airways and Healing With Loss of Ciliated Epithelium

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Abstract
In 54 patients examined at autopsy, the acute tracheal erosions produced by two types of commercially available endotracheal tubes with inflatable cuffs were similar to those induced by two types of cuffed tracheostomy tubes. The erosions exposed portions of the tracheal cartilages within 12 to 48 hours. Healing of the circumferential tracheal erosions often was accompanied by the loss of the submucosal mixed mucous and serous glands and the replacement of the normal ciliated epithelium by stratified squamous epithelium. Such a zone in a long-term survivor may become a substantial barrier to removal of particulate matter from the tracheobronchial tree. Additional complications of controlled ventilation included mediastinal and subcutaneous air dissection, tension pneumothorax, perforation of the esophagus, bronchial obstruction, hemorrhage, and signs suggestive of adult oxygen toxicity. Hemorrhage appeared to be more common in patients receiving anticoagulants.