Management of post intubation tracheal stenosis

Abstract

Background: Postintubation tracheal stenosis (PITS) is caused by a number of etiologies demanding mechanical ventilation and application of endotracheal or tracheostomy tubes which in turn conflict regional ischemic necrosis of the airway at various levels, presenting the characteristic signs and symptoms of airway obstruction. The incidences of PITS have been decreased with the recognition of the causes, and modification of endotracheal tubes and methods of management. Patients and Methods: Fifty four patients were identified between June 2017 and June 2019. Those patients were treated for tracheal stenosis which developed after prolonged endotracheal intubation. The study was done in Cardiothoracic Surgery departments at Kasr-Alainy Hospital (Cairo University). Patients were managed by rigid bronchoscopic dilatation, airway devices (as Montgomery t-tube or metallic stent) and/or primary tracheal resection and end to end anastomosis. Results: Out of the 54 patients: Three (5.5%) were planned for tracheostomy from the start. Fifty-one (94.4%) were subjected to rigid bronchoscopic examination & dilatation. Three patients (5.5%) were fully improved after bronchoscopic dilatation. The rest of the patients (48) were directed to the next stage in our management, either staged management or resection anastomosis.