(630) Risk Factors for Macroglossia in a Neurocritical Care Population: A Case-Control Study

Introduction: Macroglossia has notable consequences such as dysphagia, respiratory failure requiring intubation, and prolonged mechanical ventilation (MV). The aim of this study is to assess risk factors for macroglossia in a neurocritical care population.

Methods: A retrospective, single-center, case-control study was conducted of 28 adult patients admitted to a neurosciences ICU with a diagnosis of macroglossia between January 2015 – December 2022. Cases were matched 1:1 to random controls identified via an admissions report. In addition to basic demographic data, characteristics collected were documented tongue trauma, current ACE-I (angiotensin-converting enzyme inhibitor) /ARB (angiotensin receptor blocker) use, prolonged MV and continuous sedation >10 days, and receipt of anti-epileptic drugs (AEDs), IV (intravenous) contrast, IVIG (intravenous immunoglobulin), alteplase, and pentobarbital. Characteristics of cases and controls were compared. Odd ratios were calculated to estimate effect size of each variable.

Results: A total of 56 cases were reviewed. The macroglossia cohort included 57% (n=16) males, with a median age of 65 and the control group included 39% (n=11) males with median age 63. No significant difference was seen in current ACE-I/ARB use or receipt of AEDs, IVIG, alteplase, and IV contrast. Tongue trauma was observed in 14 macroglossia patients and 1 control patient (OR 27, CI 3.2 – 226.9). MV > 10 days occurred in 18 macroglossia patients and 6 control patients (OR 6.6, CI 2.01 – 21.7) and continuous sedation > 10 days occurred in 12 macroglossia patients and 2 control patients (OR 9.8, CI 1.9 – 49.3). No patients in the control group and 6 patients in the macroglossia group received pentobarbital (RR = 2.27).

Conclusions: This study demonstrated potential risk factors for macroglossia in a neurocritical care population include tongue trauma and pentobarbital administration. There is an association of macroglossia with longer duration of MV and sedation which may reflect a consequence of macroglossia rather than causality. A larger case-control study with matching to multiple control groups is needed to confirm these findings.