Incidence Of Tracheal Stenosis Research Articles

Histologic evidence of tracheal stenosis directly resulting from SARS-CoV-2 tissue infiltration, a case series

BackgroundThere has been an anecdotal increase in the incidence of tracheal stenosis that has coincided with the SARS-CoV-2 pandemic.Case presentationThis is a case series in which we report clinical and pathologic findings of two patients who subsequently developed subglottic tracheal stenosis after having been hospitalized with COVID-19 pneumonia. Histopathologic analysis of tissue from these patients shows features consistent with tissue infiltrated with SARS-CoV-2 virus, namely multinucleated syncytial cells with prominent nucleoli.ConclusionOur findings directly implicate SARS-CoV-2 in the pathogenesis of tracheal stenosis.

Safety of percutaneous dilatational tracheotomy (PDT) with the rigid tracheotomy endoscope (TED): a 6-month follow-up multicenter investigation

BackgroundThe rigid tracheotomy endoscope (TED) was recently introduced to improve the fiberoptic technique during percutaneous dilatational tracheotomy (PDT) in critically ill patients. The aim was to evaluate the long-term complications of PDT using TED equipment in a prospective multicenter investigation.MethodsOne hundred eighty adult patients underwent PDT using TED in four German hospitals. Patients who were alive or their guardians were contacted via telephone and interviewed using a structured questionnaire 6 months following the tracheostomy procedure. Patients with airway complaints were invited for outpatient clinical ENT examination. The incidence of adverse events related to PDT was registered.ResultsOf 180 patients who received tracheostomy, 137 (76.1%) were alive at the time of follow-up. None of the 43 lethal events was related to the PDT. Fifty-three (38.7%) patients were available for follow-up examination, whereas 14 (10.2%) were able to visit ENT physicians. Two (3.8%) out of 53 patients developed tracheocutaneous fistula with required surgical closure of tracheostoma. Dyspnea (7.5%), hoarseness (5.7%), stridor and swallowing difficulties (both with 3.8%) were the most common complaints. Tracheal stenosis was confirmed in 1 patient (1.88% [95% CI: 0.33; 9.93]).ConclusionThe use of TED for PDT in the clinical setting is safe regarding adverse events at 6-month follow-up. The incidence of tracheal stenosis after PDT with TED is comparable with that of flexible bronchoscopy; however, its role for PDT at the intensive care unit should be clarified in further investigations.

Bioinformatics analysis and verification of gene targets for benign tracheal stenosis.

BackgroundTracheal injury could cause intratracheal scar hyperplasia which in turn causes benign tracheal stenosis (TS). With the increasing use of mechanical ventilation and ventilator, the incidence of TS is increasing. However, the molecular mechanisms of TS have not been elucidated. It is significant to further explore the molecular mechanisms of TS.MethodsThe repeatability of public data was verified. Differently expressed genes (DEGs) and most significant genes were identified between TS and normal samples. Enrichment analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were analyzed. The comparative toxicogenomics database were analyzed. TS patients were recruited and RT‐qPCR were performed to verify the most significant genes.ResultsThere exist strong correlations among samples of TS and normal group. There was a total of 194 DEGs, including 61 downregulated DEGs and 133 upregulated DEGs. GO were significantly enriched in mitotic nuclear division, cell cycle, and cell division. Analysis of KEGG indicated that the top pathways were cell cycle, and p53 pathway. MKI67(OMIM:176741), CCNB1(OMIM:123836), and CCNB2(OMIM:602755) were identified as the most significant genes of TS, and validated by the clinical samples.ConclusionBioinformatics methods might be useful method to explore the mechanisms of TS. In addition, MKI67, CCNB1, and CCNB2 might be the most significant genes of TS.

Iatrogenic subglottic tracheal stenosis after tracheostomy and endotracheal intubation: A cohort observational study of more severity in keloid phenotype.

BackgroundTracheostomy and endotracheal intubation can result in subglottic tracheal stenosis, and predisposition to keloid scar formation can increase stenosis risk after tracheal injury. This study aims to compare the incidence and severity of subglottic tracheal stenosis in keloid and non‐keloid patients following iatrogenic tracheal injury, in particular tracheostomy.MethodsFrom 2012 to 2017, 218 573 patients were intubated for surgery; 2276 patients received tracheostomy in People’s Hospital of Zhengzhou University, China. Among these patients, 133 patients, who developed tracheal stenosis after intubation and/or tracheostomy, were divided into keloid or non‐keloid groups; their Myer and Cotton grading of tracheal stenosis, time‐to‐onset of airway stenosis, and treatment outcome were assessed and compared.ResultsThe percentages of high grade (Myer and Cotton grading III/IV) tracheal stenosis were higher among keloid patients than non‐keloid patients (intubation: 83.3% vs 25.7%; tracheostomy: 77.7% vs 33.3%). Time‐to‐onset of airway stenosis following intubation (tracheostomy) was 27 ± 5 (38 ± 13) and 41 ± 7 (82 ± 14) days for keloid and non‐keloid patients, respectively (P < 0.01). The incidence of tracheal stenosis is higher in keloid than non‐keloid subjects (19.4% vs 1.82%, P < 0.001). Keloid patients also required more frequent treatment (P < 0.01) of longer duration, yet cure rate was significantly lower (P < 0.01).ConclusionsOur study suggests that tracheostomized patients with keloid phenotype are more susceptibility to develop iatrogenic tracheal stenosis of greater severity and with poorer treatment outcome. Greater cautions may be required when performing tracheostomy in keloid subjects. More substantive analysis is warranted to establish keloid phenotype as a risk factor for tracheal stenosis.

Tracheal Stenosis After Endotracheal Intubation and Percutaneous Dilatational Tracheostomy

Introduction&#x0D; Tracheal stenosis is an abnormal narrowing of the tracheal lumen which affects adequate airflow and caused by an inflammatory complication such as endotracheal intubation and percutaneous dilatational tracheostomy (PDT). Incidence of tracheal stenosis following endotracheal intubation and PDT was 8-44%.&#x0D; Case Report&#x0D; A 24 year old female presented with dyspnea and hoarseness after traffic accident. She was intubated for 2 weeks then followed by PDT for 3 weeks. The laryngoscopy examination after PDT extubation showed tracheal stenosis at the second-third tracheal ring with left vocal fold granuloma. Cervical computed tomography demonstrated a mass at vocal cord and narrowing of tracheal caliber at the first thoracic vertebra disk, above the stoma of PDT.The granuloma was excised and tracheal stenosis was removed by tracheal resectionand end-to-end anastomosis. &#x0D; Discussion&#x0D; Tracheal stenosis is one of important sequelae after endotracheal intubationand PDT. Tracheal resection and primary anastomosis may be considered as an option for surgical management of tracheal stenosis.

Late Endobronchial Wegener's Granulomatosis

CASE A 58-year-old man with a known diagnosis of Wegener's granulomatosis (WG) since 1990 was treated with prednisone and Cytoxan for 3 to 4 years until he was thought to be in remission. Despite the therapies, he continued to have shortness of breath and bilateral recurrent pneumonia. Flexible bronchoscopy revealed 20%, 90%, and 100% stenosis of the subglottic trachea, truncus intermedius (Fig. 1), and lingular bronchus respectively.FIG. 1.: Diffuse narrowing and multiple strictures involving the entire truncus intermedius in a patient with Wegener's granulomatosis.DISCUSSION WG is an idiopathic, multisystem disease characterized by necrotizing granulomatous inflammation and vasculitis that involves primarily the upper and lower respiratory tracts with associated glomerulonephritis. 1–5 Actually, WG can involve the entire respiratory tract from the nasal septum to the pleura. 6 A limited form, with a clinical finding isolated to the upper respiratory tract or the lungs, occurs in approximately one fourth of cases. 1,5,7,8 The lung is the most frequent and sometimes the only organ involved. It has been suggested that the pulmonary involvement results from enhanced exposure to inhaled substances and/or a respiratory infection combined with unique susceptibility factors found in the host. 1,9 Approximately 85% of patients develop lung involvement during the course of the disease, 6,10,11 and 45% have lung involvement at presentation. 11 Two thirds of the former group have respiratory symptoms with active disease, whereas the remaining patients are asymptomatic despite an abnormal chest radiograph. 6 In WG, pulmonary symptoms include cough, hemoptysis, and pleuritis. 1,6 The radiographic findings usually include nodules that may cavitate and are seen in half the patients, as well as alveolar and pleural opacities. 1,6 Also, lobar and segmental infiltrates or atelectasis secondary to endobronchial disease have been reported. 6,8,12 Hemoptysis is the most frequent symptom, which leads patients to undergo bronchoscopy frequently (55–59%), revealing gross endobronchial abnormalities such as isolated hemorrhage, airway inflammation, ulcerations, bronchial stenosis, and pseudotumors. 4,6,11,13 Inflammation and stenosis of the endobronchial airways has been found to occur in at least 15% of patients with lung involvement. 9,13 One of the locations where WG can cause irreversible damage is the tracheobronchial tree, which could be potentially life-threatening. 2,13 The incidence of tracheal stenosis has been reported to be 16%. 2,14 The incidence of subglottic involvement has also been reported with similar frequency. 2,5,6,14–17 Subglottic stenosis sometimes develops during the course of the disease and is a result of circumferential inflammation, edema, and fibrosis that typically extends for 3 to 4 cm below the vocal cords, 16 and results in long-term morbidity. Our patient presented with symptoms of airway obstruction and was found to have subglottic stenosis as well as stricture involving the entire truncus intermedius. Another form, called ulcerating tracheobronchitis, which is characterized by focal or diffuse airway narrowing as a result of the inflammation and edema, 6,16 can accompany WG. Also, hilar adenopathy and mediastinal masses are not uncommon with WG. 10 The diagnosis of WG relies heavily on pathologic documentation of granulomatous inflammation, necrosis, and vasculitis. 1,6,9,10,18,19 Open lung biopsy is the most sensitive method for establishing the diagnosis because it demonstrates necrotizing granulomatous vasculitis in 70% of patients. 1,3,18 Endobronchial lung biopsy has a role in the diagnostic evaluation of WG when it exhibits ulcerative, exophytic, or stenotic tracheobronchial lesions. 1,3,5,6,13,18–21 Therapeutic interventions for endobronchial WG depend on the presence or absence of airway inflammation. Airway inflammation suggests acute disease and may respond to systemic treatment. 9,15 Conversely, airway stenosis (subglottic or tracheal) may suggest a burned-out, late, irreversible aftermath of WG. Under the circumstances, interventions such as laser photoresection, dilation, and stent placement may be necessary. 9,13,15,16 Our patient underwent endobronchial photoresection using the Nd:YAG laser, balloon bronchoplasty, and mitomycin applications to the treatment areas.

Tracheal stenosis and congenital heart disease in patients with Down syndrome: diagnostic approach and surgical options

Upper airway obstruction is a prevalent feature in patients with Down syndrome. However, these patients may be completely asymptomatic in the early months of life. The recognition of a problem within the airway quite often occurs when these children present for cardiac surgery, diagnostic radiography with sedation, or during the induction and intubation for anesthesia. Tracheal stenosis is rare in the general population, but is seen somewhat more frequently in patients with Down syndrome. The incidence of tracheal stenosis in children with congenital heart disease, which is seen in 40% of patients with Down syndrome, has been reported to be 1.2%. Patients with Down syndrome also tend to have other upper airway obstructive pathology such as nasopharyngeal, oropharyngeal, and subglottic compromise. These entities, combined with the high incidence of cardiac disease, put these children at risk for acute and chronic cardiopulmonary compromise. We present two patients with Down syndrome and congenital heart disease who were found to have significant tracheal stenosis at the time of their cardiac surgery. The perioperative management of their airway defects including diagnostic evaluation and treatment modalities are discussed.

Percutaneous dilatational tracheostomy: Surgical technique

Percutaneous dilatational tracheostomy (PDT) has become a popular method of tracheotomy over the past decade because it is cost effective and can be used at the bedside. The operative technique is reviewed in this article. The literature shows that PDT does not have a higher perioperative complication rate than standard operative tracheotomy, but one potential complication of PDT is failure to control the airway, because there is no direct visualization of the trachea. Therefore the surgeon should be prepared to convert to standard operative tracheotomy if urgent airway control becomes necessary. The incidence of tracheal stenosis after decannulation of PDT patients is reviewed, and appears to be similar to that for standard operative tracheotomy.

Percutaneous dilational tracheostomy as the preferred method of airway management

Tracheostomy is frequently required for the management of patients requiring prolonged mechanical ventilatory support. Open tracheostomy performed in the operating room or at the bedside has been the standard. Percutaneous tracheostomy was first described in 1955 by Shelden et all as an alternative technique that could be performed at the bedside.l The procedure involved blind cannulation of the trachea with a bladed instrument and was not widely accepted. A number of variations on the percutaneous method have been described, but none have gained widespread clinical acceptance.2-4 Toy and Weinstein* were the first to describe a percutaneous technique that used a guide-dilator complex to allow for safer carmulation of the trachea. Using a modification of Toy’s method, Ciaglia and his colleagues introduced the percutaneous dilational tracheostomy (PDT), which uses a series of dilators passed over a flexible Seldinger wire.5a6 Ciaglia and others have reported very favorable results with PDT.6-10 In direct comparison studies, complication rates for PDT compared favorably with the complication rates for open tracheostomy.“-15 Early criticism of PDT came because advocates had not provided convincing data on the procedural complications and the incidence of tracheal stenosis. A number of more recent prospective studies show procedural complications and stenosis rates that are lower than those reported for open tracheostomy.‘“-l9 There is now a large body of literature that clearly

Symptomatic tracheal stenosis in burns

Tracheal stenosis in burns is rare and usually results from prolonged intubation or tracheostomy. Inhalation injury itself has the potential risk of tracheal stenosis. We reviewed the records of 1878 burn patients during 1987 to 1995 and found seven with tracheal stenosis (0.37%) after an average of 4.4 years follow up. There were 4 males and 3 females with an average age of 27.3 years. The tracheal stenosis developed 1–22 months after burn (average 7 months). Five patients had their inhalation injury confirmed by bronchoscopic examination. The incidence of tracheal stenosis among inhalation injury patients was 5.49% (5/92). Six patients needed intubation in the initial stage either for respiratory distress or prophylaxis, with an average duration of 195.2 h. In addition to prolonged intubation, the presence of inhalation injury, repeated intubations and severe neck scar contractures are also contributors to tracheal stenosis in burns. We favor T-tube insertion as the first treatment choice; permanent tracheostomy was unsatisfactory in our study.

Late Complications of Percutaneous Dilatational Tracheotomy

To assess the late complications of percutaneous dilatational tracheotomy, particularly the incidence of tracheal stenosis and voice changes. Prospective descriptive clinical study. Teaching hospital, the Netherlands. Eighty consecutive patients who were successfully decannulated after percutaneous tracheotomy. Fourteen patients died after decannulation, of tracheotomy-unrelated causes. Sixty-six patients were followed up 3 to 39 months after decannulation (mean, 16 months). Fifty-four patients underwent tomography of the trachea. In 14 patients (26%), there was tracheal narrowing of more than 10%. Data analysis showed that these stenoses were operator dependent (p = 0.03). Voice changes, found in 13 (21%) of 61 patients, were major in 1 and minor in 12. Scars were generally cosmetically acceptable. Retraction of the scar, seen in 13 (19%) of 66 patients, was related to the duration of cannulation (p = 0.002). A persistent tracheocutaneous fistula was present in two patients. The incidence of tracheal stenosis after percutaneous dilatational tracheotomy is low compared with conventional tracheotomy. Experience with the technique is important to avoid late complications.