The high risk of postintubation tracheal stenosis in patients intubated for organophosphate poisoning

Abstract

Amac: Bu calismada entubasyon sonrasi trakea stenozu gelisen hastalar, entubasyonun birincil nedeni ve tedavisine gore tekrar degerlendirildi. Ca­lis­ma­pla­ni:­Ocak 2001 Aralik 206 tarihleri arasinda yogun bakim unitesinde cesitli nedenler ile endotrakeal entubasyon uygulanan 230 hasta arasindan entubasyon sonrasi trakeal stenoz gelisen 14 hasta retrospektif olarak incelendi. Hastalarin tumu boyun ve gogus bilgisayarli tomografi taramasi ile degerlendirildi ve trakeal anastomoz yapildi. Rezeke edilen stenotik trakeal halkalar, histopatolojik olarak degerlendirildi. Bul gu lar: Hastalarin toplam 201’ine genel travma (GT), 29’una ise organik fosfor zehirlenmesi (OFZ) nedeni ile endotrakeal entubasyon uygulandi. On dort olguda trakeal stenoz gelisti, bu olgularin dokuzu OFZ, besi GT hastasi idi. Organik fosfor zehirlenmesi olan hastalarda yuksek doz atropin veya pralidoksim tedavisi disinda, medikal tedavi ve bakim her iki grupta genel olarak benzer idi. Rezeke edilen stenotik trakeal halkalarda, yaygin kronik aktif inflamasyon, fibrozis ve epitel kaybi OFZ grubunda, GT grubundan daha fazla idi. So­nuc:­Entubasyonun birincil nedeni ve medikal tedavinin, entubasyon sonrasi trakeal stenoz gelisimine etkisi olabilir. Anah tar soz cuk ler: Yogun bakim; postentubasyon; trakeal stenoz; trakeal cerrahi. Background:­This study aims to reevaluate patients who developed postintubation tracheal stenosis with regard to the primary reason for intubation and therapy. Methods: Between January 2001 and December 2006, 14 of 230 patients who underwent endotracheal intubation for various reasons in the intensive care unit (ICU) and then developed postintubation tracheal stenosis were analyzed retrospectively. All patients were examined with a neck and chest computed tomography (CT) scan, and tracheal anastomosis was performed. The resected stenotic tracheal rings were evaluated histopathologically. Results:­ A total of 201 patients underwent endotracheal intubation due to general trauma (GT), and 29 of these were due to organophosphate poisoning (OPP). Fourteen of these patients developed tracheal stenosis, including nine with OPP and five with GT. The medical therapy and care were generally similar in both groups, except that high doses of atropine and/or pralidoxime were administered to the OPP patients. Diffused chronic active inflammation, fibrosis, and epithelial loss in the resected stenotic tracheal rings were more common in the OPP group than in the GT group. Conclusion:­ The primary cause of intubation and the medical therapy employed may have an effect on postintubation tracheal stenosis.