The place of airway stenting in the medico-surgical management of iatrogenic tracheal injuries: A 10 years retrospective analysis

Abstract

Background: Iatrogenic tracheal injuries (ITI) are serious complications of endotracheal tube placement and of tracheostomy. Aims and objectives: Define the use of airway stents in ITI management. Material and methods: Between 2004 and 2014, we retrospectively analyzed 35 charts of patients referred to our endoscopic suite for suspected ITI. Patients presenting with tracheoesophageal fistula (TEF) underwent surgical repair. Among the remaining patients, those free from mechanical ventilation (MV) were treated conservatively with endoscopic surveillance. Mechanically ventilated patients were managed either by placing ETT or tracheostomy cuffs in the lower trachea when ITI was located in the upper trachea, or by Y-stent placement when ITI was located in the lower trachea (ETT or tracheotomy cannula placed inside the Y-stent). Results: Four patients presented with TEF, 3 (8.57%) underwent surgical repair and one was treated with an esophageal stent. Seven patients (20%) did not require MV and were managed conservatively. Of the 24 remaining ventilated patients, 7 (20%) patients were treated with Y-stent placement and 17 (48.57%) by placing the ETT or tracheostomy cuff distal to the ITI. Overall management success rate was 88.57%, 4 patients (11.43%) deceased secondary to co-morbidities. Conclusions: Conservative management should be considered in non-ventilated patients and in ventilated-patients presenting ITI located in the upper trachea. Airway stenting should be considered as a valid option in ventilated-patients whose ITI are located in the lower trachea. Surgery should be reserved in case of TEF or conservative management failure.