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. 2025 Aug 26.
doi: 10.1002/ohn.70012. Online ahead of print.

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

Nickolas A Davies  1 , Mason G Johnson  2 , Abigail F Schirmer  3 , Logesvar Balaguru  2 , Matthew Nuzzi  4 , Neil N Chheda  2 , Nikolaus Gravenstein  3
Affiliations

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

Nickolas A Davies et al. Otolaryngol Head Neck Surg. .

Abstract

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.

Keywords: COVID‐19; endotracheal tube; glottic; intubation; larynx position; prone; stenosis; subglottic.

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