Laryngeal Injury After Prone Positioning: A Cadaveric Evaluation of Endotracheal Contact Pressures

Laryngotracheal stenosis (LTS) has been described as a complication of prolonged intubation. Early in the COVID-19 pandemic, many patients were intubated and ventilated for a long period, often in the prone position. To investigate the physical effects of prone versus supine positioning and its possible correlation to LTS, this research used two Thiel-embalmed cadavers, one male and one female, and a novel pressure sensor device, to directly measure the force applied by an endotracheal tube onto the posterior glottis. The male cadaver's mean posterior glottic force was 388 g supine (range 200-885 g) and 662 g prone (range 398-892 g) (P < .001). The female cadaver's mean posterior glottic pressure was 586 g supine (range 202-1794 g) and 1659 g prone (range 944-2183 g) (P < .001). Both cadavers experienced a significantly higher posterior glottic pressure in the prone position, with a higher increase in the female cadaver compared to the male cadaver.