Role of Prolonged Intubation in Vocal Fold Motion Impairment in Critically Ill Patients.

OBJECTIVE: COVID-19 upsurge in orotracheal intubation (OTI) has opened a new opportunity for studying associated complications. Vocal fold motion impairment (VFMI) is a known complication of OTI. The present study sought to determine the impact of OTI and prolonged OTI on the risk of developing VFMI; to identify both risk and protective factors associated with it. STUDY DESIGN: Retrospective cohort study. SETTING: Multicenter. METHODS: Medical charts were reviewed for all patients that received invasive mechanical ventilation with a subsequent flexible laryngoscopic assessment between March 2020 and March 2022. The main outcomes were the presence of VFMI, including immobility (VFI) and hypomobility (VFH). RESULTS: A total of 155 patients were included, 119 (76.8%) COVID-19 and 36 (23.2%) non-COVID-19 patients; overall 82 (52.9%) were diagnosed with VFMI. Eighty (52.3%) patients underwent a tracheostomy. The median (IQR) intubation duration was 18 (11-24.25) days, while the median (IQR) time to tracheostomy was 22 (16-29). In the adjusted model, we observed there was a 68% increased risk for VFMI from day 21 of intubation (RR: 1.68; 95% CI 1.07-2.65; P = 0.025). CONCLUSIONS: VFMI is a frequent complication in severely ill patients that undergo intubation. A prolonged OTI was associated with an increased risk of VFMI, highlighting the importance of timely tracheostomy. Further research is needed to confirm these findings in other subsets of critically ill patients.

Formability of the 5754-Aluminum Alloy Deformed by a Modified Repetitive Corrugation and Straightening Process.

Sheets of 5754-aluminum alloy processed by a modified repetitive corrugation and straightening (RCS) process were tested in order to measure their formability. For this purpose, forming limit curves were derived. They showed that the material forming capacity decreased after being processed by RCS. However, they kept good formability in the initial stages of the RCS process. The formability study was complemented with microstructural analysis (derivation of texture) and mechanical tests to obtain the strain-rate sensitivity. The texture analysis was done by employing X-ray diffraction, obtaining pole figures, and the orientation distribution function. It was noticed that the initial texture was conserved after successive RCS passes, but the intensity dropped. RCS process did not induce ß-fiber, contrary to common deformation process. The strain-rate sensitivity coefficient was measured through tensile tests at different temperatures and strain rates; the coefficient of the samples processed after one and two passes were still relatively high, indicating the capacity to delay necking, in agreement with the good formability observed in the initial passes of the RCS process.