Peak Expiratory Flow decrease signals relapse in patients with post intubation tracheal stenosis.

Abstract

Post Intubation Tracheal Stenosis (PITS) is a severe iatrogenic complication which even after surgical or interventional management may relapse and become life threatening. Early symptoms may be absent and close follow up with regular bronchoscopic inspections are warranted to prevent acute deterioration of airway patency. We aimed to examine whether regular pulmonary function testing (PFTs) could detect early relapse of tracheal stenosis in PITS patients after management and thus avoid unnecessary bronchoscopies (BS). We examined 23 patients with PITS treated either surgically (3) or interventionally (20). PFTs and BS were part of follow-up visits at 15 days, 1-3-6 months and 1 year post-treatment. Emergency visits were included for acute dyspnea. Prior to each BS, we examined mMRC dyspnea score and PFTs parameters as indicators of relapse (bronchoscopic estimation of restenosis >50% of airway caliber). During follow-up period 14/23 patients experienced 18 relapses either after dilatation (13/18) or stent placement (5/18). Peak Expiratory Flow (PEF) was significantly reduced in cases of relapse (ΔPEF -13 to -60%, mean -40%) in comparison to the non-relapse cases (ΔPEF -5 to +12%, mean 6%) (p<0.05). No statistically significant correlation were found for mMRC or other functional parameters (FEV1, FVC). Measurement of PEF is closely correlated to restenosis of the central airway after treatment in patients with PITS. It is an easy maneuver which can also be performed at home with a portable flowmeter not requiring Hospital visits or complete PFTs. Patients may detect relapse early enough before severe dyspnea develops while avoiding unnecessary bronchoscopy during follow up period.