Rigid bronchoscopic dilatation of postintubation tracheal stenosis

Abstract

Postintubation tracheal stenosis (PITS) occurs due to excessive pressure on the trachea by the cuff of the endotracheal tube which leads to local ischaemic necrosis of the tracheal cartilage and excessive growth of granulation tissue. The recognition of its aetiology and modifications in the design and management of endotracheal tubes have led to a diminished incidence of PITS. The management modalities that have been employed for the management of PITS include stenting, surgical resection and reconstruction, percutaneous dilatation, rigid bronchoscopic dilatation, fibreoptic assisted balloon dilatation and Nd:YAG (neodymium: yttritium-aluminum garnet) laser therapy with or without stenting. Three female patients with a history of varying periods of endotracheal intubation after a period of acute respiratory failure who developed symptoms of tracheal stenosis 1-2 weeks post-extubationare presented. The mean age was 24 +/- 12.49 years (range = 14-38 years). All the three patients were successfully managed by frequent, rigid bronchoscopy and gradual dilatation until the resolution of the tracheal stenosis and the return of pulmonary function tests (PFT) to normal. Rigid bronchoscopic dilation in patients with PITS provides safe, effective tracheal dilatation and improved pulmonary function in the medium term.