Development Of Tracheal Stenosis Research Articles

Traumatic tracheal rupture in closed chest trauma (a clinical case)

The purpose was to present a clinical case of a soldier with a rupture of the cervical and thoracic parts of the trachea due to closed chest trauma. Early and complete diagnosis of chest injuries, which includes mandatory X-ray and fibrobronchoscopy, can save the life of an injured person, helps choose the optimal method of treatment and improve its outcomes. When choosing the therapeutic approach in patients with traumatic tracheal injuries, it is extremely important to take into account the mechanism of injury, the nature of tracheal damage, the presence and severity of post-traumatic complications, the general condition of the patient, and capacities of a healthcare institution. Given the frequent occurrence in the acute period of life-threatening complications due to traumatic tracheal injury, the formation of gross scarring with the development of tracheal stenosis is possible in the long term, preference is given to active surgical correction of traumatic changes in the tracheal wall. Traumatic injury to the tracheobronchial tree should be suspected in all injured patients with subcutaneous emphysema, hemoptysis, and dyspnea. Adequate examination and treatment of patients with traumatic tracheal rupture requires highly specialized medical care that is based on knowledge, experience, and skills for managing such trauma. X-ray and fibrobronchoscopy must be included in the examination algorithm of such patients. When choosing the treatment approach in patients with traumatic tracheal injuries, it is extremely important to take into account the mechanism of injury, the general condition of the patient, the presence of post-traumatic complications, and capacities of a healthcare institution. Conservative treatment for traumatic tracheal rupture with timely use of minimal surgical interventions can be successful in complete ruptures of the membranous wall of the medium length without development of life-threatening complications.

The evaluation of the trachea as a new parameter in determining the prognosis of COVID-19: first pilot study.

Coronavirus disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) follows a biphasic disease model consisting of an early viral response phase and an inflammation phase. SARS-CoV-2 has a high affinity for the upper respiratory tract and conjunctiva; hence, it can infect the upper respiratory tract and facilitate airway inflammation. COVID-19 also affects the tracheal epithelial cells. We hypothesized that the size of the trachea increases depending on the severity of the disease, and this increase is an indicator of poor prognosis. There are no studies on this subject in literature, to the best of our knowledge. For this purpose, in this study, the tracheas of 326 patients who reported to the radiology clinic were examined by evaluating the thoracic computed tomography (CT) images. The patients who were admitted to the Malatya Training and Research Hospital between September and December 2020, had a positive SARS-CoV-2 nasopharyngeal reverse transcription-polymerase chain reaction result, and had undergone thoracic CT, were included in the study. The thoracic CT scans without respiratory artifacts were evaluated, and anteroposterior (AP) and transverse diameters of the trachea were measured at the thyroid and bifurcation levels. We believe that a tracheal AP diameter of >20 mm at the thyroid level and a tracheal AP diameter of 18 mm at the thyroid bifurcation level (according to Group 3 and Group 4) may be indicators of poor prognosis. In terms of survival, a tracheal AP diameter of >18 mm at the bifurcation level can be considered as a poor prognostic factor. The tracheal diameter may increase in proportion to the severity of inflammation, indicating or accompanying a poor prognosis. Patients with extensive involvement should be monitored closely for the development of tracheal stenosis.

Effects of transforming growth factor-beta-1 neutralizing antibody and transforming growth factor-beta-3 on the development of tracheal stenosis

Effects of transforming growth factor-beta-1 neutralizing antibody and transforming growth factor-beta-3 on the development of tracheal stenosis

Feasibility and safety of dilatational tracheotomy using the rigid endoscope: a multicenter study

BackgroundFiberoptic tracheo-bronchoscopy is the most commonly used procedure for percutaneous dilational tracheotomy (PDT). However, PDT can be associated with major complications, including death. Furthermore it is unclear, whether the tracheal ring fractures may contribute to the development of tracheal stenosis after PDT nor whether tracheal ring fractures can be prevented by using a rigid endoscope for this procedure. The purpose of this study was to evaluate the feasibility of and the incidence of complications for PDT using the rigid tracheotomy endoscope (TED).MethodsIn a prospective multicenter observational study from 2006 to 2010, 180 adult patients in intensive care and those scheduled for ear, nose and throat surgery underwent PDT using TED. Data collection was performed using a structured protocol. The patients were observed according to PDT phase (phase 1: puncture, phase 2: dilatation and phase 3: cannula insertion). The descriptive data are given as the number (percent) of cases and the mean ± standard deviation (SD) where appropriate. The relationships between dichotomous and categorical parameters were analyzed using the chi-square test. P values ≤ 0.05 were considered significant.ResultsPDT was performed in 179 patients. The procedure time was 14.8 ± 6.2 (mean ± SD) minutes. Pneumothorax or procedure-related lethal complications did not occur. Other adverse events included tracheal ring fractures (17.1%), desaturations (6.8%), special incidents (6.2%), bleeding (5.5%), anesthesia complications (4.5%) and posterior tracheal wall injuries (1.1%).ConclusionThe use of TED in PDT is feasible, and the incidence of complications and adverse events was comparable with that of PDT using the flexible endoscope. Tracheal ring fractures in PDT cannot be avoided by the use of a rigid endoscope. With TED, the airway always remains open thus the use of jet ventilation via the TED during PDT is possible.

Cuffed endotracheal tubes in neonates and infants undergoing cardiac surgery are not associated with airway complications

Study ObjectiveTo determine the incidence of postoperative airway complications in infants <5kg in weight undergoing cardiac surgery intubated with Microcuff (Kimberley-Clark, Roswell, GA) endotracheal tubes (ETTs). DesignRetrospective review of infants weighing <5.0 kg with congenital heart disease (CHD) presenting for cardiac surgery. SettingSingle-center, tertiary pediatric cardiac critical care unit at a university hospital. PatientsA total of 208 infants weighing <5 kg underwent cardiac surgery for CHD from 2008 to 2013. InterventionIntubation with Microcuff (Kimberley-Clark) ETTs. Study DesignRetrospective review of infants weighing <5.0 kg with CHD presenting for cardiac surgery to a single-center tertiary care university hospital. Measurements: Perioperative data were collected. Primary outcome was development of tracheal stenosis and/or reintubation for stridor. Stridor was defined as mild (≤2 doses of racemic epinephrine), moderate (>2 doses of racemic epinephrine), or severe (requiring reintubation). Secondary outcomes were variables possibly contributing to postextubation stridor. Infants with a tracheostomy, airway anomalies, and death prior to initial extubation were excluded. Logistic regression analysis was performed to evaluate the association between clinical risk factors and the incidence of postextubation stridor. ResultsA total of 208 infants weighing <5 kg underwent cardiac surgery for CHD from 2008 to 2013; 12 subjects were excluded for death prior to initial extubation. No infant developed tracheal stenosis. The incidence of any stridor was 20.9% (95% confidence interval, 15.8%-27.1%) with severe stridor in 2 cases (1%). Age at surgery, weight, duration of intubation, dexamethasone use, and ETT size were not significantly associated with postextubation stridor. Presence of a comorbidity was significantly associated with stridor (P=.01). ConclusionsMicrocuff ETTs in infants <5.0 kg in weight undergoing cardiac surgery are associated with a low incidence of severe postextubation stridor. Because cuffed ETTs allow for improved control of ventilation/oxygenation and decreased risk of aspiration, they should be considered for use in this high-risk population. Larger studies are needed to confirm these results.

Obstructive Fibrinous Tracheal Pseudomembrane

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a relatively rare cause of failed extubation. OFTP may be more common than described in the literature. OFTP results from ischemic injury to tracheal mucosa and may be the initial stage of the development of tracheal stenosis. Early diagnosis and treatment can prevent re intubation and mortality. We present a rare case of OFTP. The patient was intubated for 3 days for asthma exacerbation and was appropriately discharged. The patient was seen the second time in the emergency room and was treated for asthma exacerbation on the same day. Because of persistent symptoms after 3 days, CT scan of the chest was performed, which indicated necrotizing tracheitis with gas formation within the tracheal wall. Bronchoscopy showed no evidence of necrosis, but there was a thick white plaque toughly adherent to the tracheal wall.

Challenges in the management of acquired tracheal stenosis: a case report

Nowadays intubation is thought to be a safe, routine and life-saving pro­ cedure. Prolonged endotracheal intubation can result in fibrin deposits and predispose to the development of tracheal stenosis. The most com­ mon site for the occurrence of intubation-induced tracheal damage is at the area in contact with the inflatable cuff. We demonstrate the case re­ port that such injuries may lead to serious complications such as tracheal and laryngeal stenosis. The treatment is quite difficult and associated with significant risk and complications.

DIFFERENTIAL PRODUCTION OF METALLOPROTEINASES AFTER INSTILLING VARIOUS URBAN AIR PARTICLE SAMPLES TO RAT LUNG

To test the hypothesis that the development of tracheal stenosis would depend on the extent of tracheal cartilaginous injury, either 90° (n=6) or 180° (n=6) of anterior wall of 4 tracheal rings were cauterized in 12 mongrel dogs using Nd-YAG laser. Beginning at 3 weeks after cauterization, 180° tracheal injury resulted in life-threatening tracheal stenosis whereas 90° injury did not. Gross and microscopic examinations showed that after 180° injury, tracheal stenosis was accompanied by the loss of tracheal cartilage and dense fibrosis. These results indicate that tracheal stenosis depends on the extent of tracheal injury in experimental canine model.

TRACHEAL STENOSIS DEPENDS ON THE EXTENT OF CARTILAGINOUS INJURY IN EXPERIMENTAL CANINE MODEL

To test the hypothesis that the development of tracheal stenosis would depend on the extent of tracheal cartilaginous injury, either 90° (n=6) or 180° (n=6) of anterior wall of 4 tracheal rings were cauterized in 12 mongrel dogs using Nd-YAG laser. Beginning at 3 weeks after cauterization, 180° tracheal injury resulted in life-threatening tracheal stenosis whereas 90° injury did not. Gross and microscopic examinations showed that after 180° injury, tracheal stenosis was accompanied by the loss of tracheal cartilage and dense fibrosis. These results indicate that tracheal stenosis depends on the extent of tracheal injury in experimental canine model.

Tracheal stenosis caused by false aneurysm of the right subclavian artery

The development of tracheal stenosis following insertion of a central venous catheter is a rare complication of this procedure. We present the case of an 81-year-old woman, who suffered acute onset of dyspnea, stridor and dysphagia 4 weeks after coronary artery bypass surgery. Investigations revealed a false aneurysm of the right subclavian artery, compressing the trachea and the oesophagus. The iatrogenic lesion was caused by the insertion of a central venous catheter via the right subclavian route. By the time symptoms developed the catheter had already been removed.

食道に対するｅｘｐａｎｄａｂｌｅ ｍｅｔａｌｌｉｃ ｓｔｅｎｔ留置が気管狭窄を増悪させた１例

食道に対するｅｘｐａｎｄａｂｌｅ ｍｅｔａｌｌｉｃ ｓｔｅｎｔ留置が気管狭窄を増悪させた１例

Tracheal Injury

Tracheal Injury

Tracheal changes in relation to different tracheostomy techniques. (An experimental study on rabbits).

An experimental study on rabbits was undertaken to evaluate the effect of the tracheostomy technique on the development of tracheal stenosis. An operation model was made for the purpose of excluding all pathogenetic factors in the formation of tracheal stenosis, except the surgical procedure. Five different operative methods were used: A. vertical incision, B. anterior wall flap, C. H-type incision, D. window-type excision, and E. subperichondreal enucleation of cartilage. The "cannulation" period was 7 days, and the animals were kept alive for another 140 days before postmortem examinations were undertaken. Minor macroscopical and microscopical changes were noted. The pathological findings were somewhat more pronounced in groups B, C and E than in the other groups. The tracheostomy technique apparently plays a minor role in the formation of tracheal stenosis.

A CASE OF MASSIVE ASPIRATION OF GASTRIC CONTENTS DURING OBSTETRIC ANAESTHESIA TREATMENT BY TRACHEOSTOMY AND PROLONGED INTERMITTENT POSITIVE PRESSURE VENTILATION

SUMMARY A case is described of massive aspiration of liquid gastric contents into the lungs of an obstetric patient undergoing general anaesthesia. Pre-operative treatment with oral alkali to neutralize gastric acid did not prevent a severe reaction in the lungs. Treatment was by general supportive measures and long-term intermittent positive pressure ventilation via a tracheostomy. Great difficulty was experienced in ventilating the lungs because of their low compliance and the large physiological deadspace. Recovery was complicated by a severe reduction in pulmonary diffusing capacity and by the development of tracheal stenosis. The factors influencing the treatment and complications are discussed.