Post-intubation Laryngotracheal Stenosis Research Articles

Risk of Post-Intubation Laryngotracheal Stenosis With Respect to COVID-19 Status in a Large Multicenter Cohort Cross-Sectional Study.

Occurrence of post-intubation laryngotracheal stenosis (LTS) with respect to COVID-19 status. Retrospective cross-sectional inpatient database. Eleven Midwest academic and community hospitals, United States. Adults, mechanically ventilated, from January 2020 to August 2022, who were subsequently readmitted within 6 months with a new diagnosis of LTS. None. Six thousand eight hundred fifty-one COVID-19 negative and 1316 COVID-19 positive patients were intubated and had similar distribution by age (median 63.77 vs. 63.16 yr old), sex (male, 60.8%; n = 4173 vs. 60%; n = 789), endotracheal tube size (≥ 7.5, 75.8%; n = 5192 vs. 75.5%; n = 994), and comorbidities. The ICU length of stay (median [interquartile range (IQR)], 7.23 d [2.13-16.67 d] vs. 3.95 d [1.91-8.88 d]) and mechanical ventilation days (median [IQR], 5.57 d [1.01-14.18 d] vs. 1.37 d [0.35-4.72 d]) were longer in the COVID-19 positive group. The occurrence of LTS was double in the COVID-19 positive group (12.7%, n = 168 vs. 6.4%, n = 440; p < 0.001) and was most commonly diagnosed within 60 days of intubation. In multivariate analysis, the risk of LTS increased by 2% with each additional ICU day (hazard ratio [HR], 1.02; 95% CI, 1.02-1.03; p < 0.001), by 3% with each additional day of ventilation (HR, 1.03; 95% CI, 1.02-1.04; p < 0.001), and by 52% for each additional reintubation (HR, 1.52; 95% CI, 1.36-1.71; p < 0.001). We observed no significant association COVID-19 status and risk of LTS. The occurrence of post-intubation LTS was double in a COVID-19 positive cohort, with higher risk with increasing number of days intubated, days in the ICU and especially with the number of reintubations. COVID-19 status was not an independent risk factor for LTS.

Post-intubation laryngotracheal stenosis: clinical presentation and management approaches

IntroductionAddressing acquired laryngotracheal stenosis presents a complex healthcare dilemma.ResultsWe present a case series of 48 acquired post-intubation laryngotracheal stenosis cases managed within our Department of ENT Surgery at Farhat Hached Tunisia. Diagnosis relied on imaging and endoscopic findings. Among these cases, 28 exhibited tracheal stenosis, with 60% falling into grade 2–3 severity. Management approaches included sole endoscopic dilation for 17 patients, surgical intervention for 19 patients, and T-tube placement for 10 patients.ConclusionsThe management of laryngotracheal stenosis poses a challenge for ENT surgeons. Prevention is paramount, encompassing various measures such as employing high-volume, high tracheostomy, and extended intubation practices.

Principles of surgical treatment of chronic post-intubation laryngotracheal stenosis in childhood

Introduction: Post-intubation stenosis of the larynx and trachea in childhood increases annually. This is associated with an increasing number of children with severe pathology of the upper respiratory tract, as well as children requiring artificial ventilation for other reasons. Until now there have been debatable questions about surgical tactics in children with chronic cicatricial laryngeal stenosis. Aim: The aim of this article is to evaluate the effectiveness of different tactics of surgical treatment of children with chronic cicatricial post-intubation stenosis of the larynx, depending on the state of the cartilaginous frame of the larynx. Materials and Methods: We have treated 47 children with chronic cicatricial post-intubation stenosis of the larynx. Preoperative examination included endoscopy and computed tomography of the larynx and trachea. We assessed the cartilaginous framework of the larynx and trachea that influenced the choice of surgical approach. For 20 children with intact laryngeal cartilaginous frame the method of endolaryngeal microsurgery using a CO2 laser was applied. This method allowed to form a wound surface by minimum submucosal resection scar tissue, which made it possible to cover the wound with mucosal microflaps to prevent restenosis. In the surgical treatment of extended stenoses of the middle larynx, there are prerequisites for repeated replacement of the wound with excess scar tissue, which in our observations was avoided by using endoprostheses for a period of 21 days. Despite it, with a lesion of the subglottic part of the larynx, the risk of restenosis remained quite high (5 out of 12 patients), even in the absence of data for damage to the cartilaginous frame of the larynx. In 27 cases of chronic post-intubation cicatricial stenosis of the larynx, in identifying of laryngeal cartilage framework lesion before surgery, extralaryngeal laryngotracheoplasty was performed. Laryngofissure was performed in 18 children, followed by stenting from 6 to 18 months with a T-shaped silicone stent, in 9 cases—one-stage laryngotracheoplasty using auto-cartilage grafts. The applied techniques have shown high efficiency, while the use of autografts made it possible to reduce the stages and duration of surgical treatment. Conclusion: The use of a CO2 laser in combination with balloon laryngoplasty in microsurgical treatment of chronic post-intubation stenosis of the larynx in children significantly expands surgical capabilities due to high accuracy and low level of damage of surrounding tissues.

Acquired subglottic stenosis in a child: A diagnostic dilemma

The most common benign cause of laryngotracheal stenosis is postintubation injury caused by mechanical ventilation in intensive care units. The incidence of postintubation laryngotracheal stenosis in pediatric population is found to be 11.3%. In this report, we present a case of Soft Subglottic Stenosis(SGS) following recurrent intubation in a 3 year old child. Elective tracheostomy and serial dilatation with tracheal intubation stylets was performed which resulted in significant improvement of airway and the child was successfully decannulated. This case report highlights the importance of high index of suspicion in diagnosis of postintubation SGS in a child and reviews the literature in regard to challenges that are faced during evaluation and management of children presenting with stridor.A

Ultrasound as a bedside tool for diagnosis of post-intubation tracheal stenosis

BackgroundScreening of post-intubation stenosis can allow early diagnosis, early management of stenosis, and possible prevention of progress. Fiberoptic bronchoscope is the gold standard for diagnosis of tracheal stenosis. Other imaging modalities as computed tomography can be considered but are not available in intensive care unit.Purpose of the studyTo evaluate the validity of ultrasound (US) as a bedside test for early diagnosis of post-intubation stenosis compared to multidetector computed tomography (MDCT) and fiberoptic bronchoscope (FOB).ResultsOut of the 50 included patients, 12 patients were found to have definite stenosis by FOB. Compared to CT, significant positive correlation was found between all ultrasound parameters (laryngeal width, tracheal diameter) and corresponding CT parameters (r = 0.798, p < 0.001; r = 0.714, p < 0.001 respectively). Compared to FOB results, the yield of MDCT chest for diagnosis of stenosis had 91.6% sensitivity and 100% specificity, while the yield of US detected by mucosal irregularity as a diagnostic tool for tracheal stenosis had comparable sensitivity (91.6%) but lower specificity (88.9%).ConclusionDue to its high sensitivity, US could help in detection of possible post-intubation laryngotracheal stenosis in critically ill MV patients.

Role of Primary Aetiology of Intubation in Acquired Laryngotracheal Stenosis: An Institutional Audit and Review of Literature.

Aetiology of acquired laryngotracheal stenosis (ALTS) is complex and heterogenous. The aim of this study is to discuss the role of primary aetiology of intubation in the development and outcomes of Post intubation Laryngo tracheal stenosis (PILTS). A retrospective review of patients diagnosed and managed as PILTS from May 2008 to January 2017 was conducted. Demography, primary aetiology of intubation, grade of stenosis, length of the stenotic segment, treatment and outcomes of these patients were recorded and analysed. Based on aetiology of intubation, patients were divided into Poisoning (I), Neurogenic (II) and Rest of aetiologies (III) group respectively. Group I had 28/52 patients (53.8%) followed by group II, 15/52(28.8%) and group III, 9/52(17.3%) respectively. Organophosphorus compound poisoning (OPP) (44.2%) was the commonest cause overall followed by Brain injury (23.1%) and Acute Respiratory Distress Syndrome (ARDS) (11.5%). Trachea (46.15%) was the commonest subsite involved in this study. 24/28(85.7%) of patients had advanced (either grade 3 or 4) subglottic stenosis. The average length of stenotic segment in the study was 18.5 ± 9.2mm (7-34mm). 39/52(74.9%) of patients underwent open surgical approaches like cricotracheal resection and anastomosis, Laryngotracheal reconstruction or Shian-Yan Lee technique. 48/52(92.3%) patients were decannulated successfully. There was no significant association between primary etiology of intubation and outcomes. We conclude that OPP and neurological disease patients are more susceptible to airway injury. The authors emphasize that clinicians should be aware of these facts and manage these susceptible patients accordingly.

Surgical treatments for post-intubation laryngotracheal stenosis in patients with central nervous system injuries.

Post-intubation laryngotracheal stenosis is a complication commonly encountered in patients with central nervous system (CNS) injuries, often preventing decannulation. To date, no data is available in the literature focusing on this issue. Our objective was to describe surgical treatments for laryngotracheal stenosis and discuss factors associated with successful decannulation in this group of patients.Medical records of patients with CNS injury who received tracheal surgeries at our institution between 2009 and 2016 were retrospectively collected and analyzed.Data on 124 surgeries in 62 patients with CNS injury were collected. The total complication rate was 20.9% with no surgical mortality. The decannulation success rate was 85.5%. Argon laser surgeries (48), diode laser surgeries (22), tracheal resection and reconstructions (R&R) (9), and tracheal T-tube placements (67) were performed. The average times from the first bronchoscopy check up to surgery and surgery to decannulation were 0.7 and 8.2 months, accordingly. The mean post-decannulation follow-up time was 13.5 months. A shift from the use of rigid bronchoscopy in the initial surgeries to laryngeal mask in the latter surgeries yielded an average decrease of 3 days in hospital length of stay (LOS). A change from initial rigid bronchoscopic core out procedures and argon laser to interventional flexible bronchoscopic resections with diode laser also decreased LOS significantly.Surgical treatments for patients with CNS injury and laryngotracheal stenosis can be safely performed with low mortality, acceptable complications, and a high decannulation success rate. The majority of patients with laryngotracheal stenosis can be managed with laser endoscopic surgeries, though tracheal R&R might still be required in selected cases. The use of laryngeal mask to secure the airway and diode laser in the intra-luminal resections improved the surgical outcome and was therefore recommended for these patients suffering from post-intubation laryngotracheal stenosis.

Plasma Ablation-Assisted Endoscopic Management of Postintubation Laryngotracheal Stenosis: An Alternate Tool for Management.

The current study was conducted to highlight the use of plasma ablation as a promising method in management of adult laryngotracheal stenosis. We present our institutional experience with a minimum follow-up of 6 months. Seventy adult patients with acquired postintubation laryngotracheal stenosis were included. Efficacy and clinical outcomes of plasma ablation in endoscopic management and eventual decannulation rate were studied. Number of patients with Myer-Cotton stenosis grades 1, 2, 3, and 4 were 20, 25, 18, and 7, respectively. The mean number of surgical interventions required in each grade of stenosis were 1, 2, 3.8, and 4, respectively. Overall, 47 patients (67%) were without tracheotomy by the end of 6 months. Plasma ablation is an effective treatment option for adult laryngotracheal stenosis, with a better success rate for lower-grade stenosis. It has lesser complications and requires fewer surgical interventions.

Montgomery tracheal t-tube stenting as a single first-line treatment in postintubation laryngotracheal stenosis

ObjectiveThe aim was to evaluate the use of Montgomery tracheal T-tube stenting as a single first-line treatment for postintubation laryngotracheal stenosis (LTS), addressing the outcomes, its main complications, and how to manage them.Materials and methodsFrom March 2012 to April 2017, 25 patients with postintubation LTS had contraindication(s) for laryngotracheal surgery and were treated by Montgomery tracheal T-tube stenting as a single first-line treatment. The preoperative, operative, and postoperative follow-up data were collected retrospectively and analyzed.ResultsSuccessful outcome was reported in 16 (64%) patients, whereas seven (28%) patients had recurrent stridor after T-tube removal. It was reinserted in two of them, and the rest were subjected to other surgical procedures. Mortality was reported in two patients. Complications of different nature, severity, and durations were reported, and most of them were detected and managed successfully by applying close follow-up protocols.ConclusionMontgomery tracheal T-tube stenting is a very valuable modality in the treatment of LTS as a single first-line treatment when surgical option is contraindicated. It has a relatively low incidence of treatable complications; however, false sense of security must be avoided to ensure good outcome.

A Multi-Modality Surgical Management in Laryngeal Stenosis

Introduction&#x0D; Postintubation laryngo-tracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngo-tracheal stenosis secondary to long-term intubation/ tracheostomy with review of the literature.&#x0D; Case Reports&#x0D; In this retrospective study, we present 5 cases (23-year-old male, 13 year old male, 22 year old male, 19 year old male and 33 year old female) of post-intubation/tracheostomy laryngo-tracheal stenosis (glottic/subglottic) stenosis in the year 2016 to 2017. Each patient was managed differently. A patient with history of multiple subglottic stenosis dilations and stenting underwent open surgical subglottic stenosis resection and anastomosis, LASER assisted resection of stenosis with stenting was done in a patient with history of dilation, LASER assisted resection and dilation followed by Mitomycin C application was done in another patient with history of poisoning, plain endoscopic dilation was done in one patient with history of head injury and Kashima’s Cordotomy with release of interarytenoid adhesion by LASER was done in one patient.&#x0D; Conclusion&#x0D; Resection of stenotic segment by open surgical anastomosis and laser assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.

Adult Post-Intubation Laryngotracheal Stenosis: An Underestimated Complication of Intensive Care?

Adult Post-Intubation Laryngotracheal Stenosis: An Underestimated Complication of Intensive Care?

Results of endoscopic tracheoplasty for treating tracheostomy-related airway stenosis

Post-tracheostomy 'lambdoid' deformity of the trachea is a specific and uncommon variant of adult post-intubation laryngotracheal stenosis, in which airway obstruction is caused by inward collapse of over-resected tracheal cartilage as a result of post-decannulation stomal contracture. We evaluated the results of endoscopic tracheoplasty as an alternative to open tracheal resection in 11 patients treated for this condition between 2004 and 2006. Patients were treated with endoscopic CO(2) laser resection, dilatation and endotracheal mitomycin C application. Suspension micro-laryngo-tracheoscopy and high-frequency supraglottic jet ventilation were used. Eleven patients with an average age of 56 years and lesion height and distance from glottis respectively of 11 +/- 5 mm and 35 +/- 12 mm were treated. The median number of treatments fell from four at the start of the series to two at the end (P = 0.08). The average follow-up was 17 +/- 8 months and all patients were cured with no cases of dysphagia or dysphonia. Almost all patients achieved and maintained a Medical Research Council Dyspnoea Scale of I or II. Endoscopic tracheoplasty is an effective treatment for this condition. It achieves a successful outcome while avoiding the operative risks, prolonged hospitalisation, and morbidity that is associated with tracheal resection. We recommend it as the standard of care for treating patients with this injury.

Estimating the population incidence of adult post‐intubation laryngotracheal stenosis

Clinical OtolaryngologyVolume 32, Issue 5 p. 411-412 Estimating the population incidence of adult post-intubation laryngotracheal stenosis S.A.R. Nouraei, S.A.R. Nouraei Department of Otolaryngology, Charing Cross HospitalSearch for more papers by this authorE. Ma, E. Ma North West London Unit (Epidemiology), Health Protection AgencySearch for more papers by this authorA. Patel, A. Patel Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this authorD.J. Howard, D.J. Howard Department of Otolaryngology, Charing Cross Hospital Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this authorG.S. Sandhu, G.S. Sandhu Department of Otolaryngology, Charing Cross Hospital Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this author S.A.R. Nouraei, S.A.R. Nouraei Department of Otolaryngology, Charing Cross HospitalSearch for more papers by this authorE. Ma, E. Ma North West London Unit (Epidemiology), Health Protection AgencySearch for more papers by this authorA. Patel, A. Patel Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this authorD.J. Howard, D.J. Howard Department of Otolaryngology, Charing Cross Hospital Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this authorG.S. Sandhu, G.S. Sandhu Department of Otolaryngology, Charing Cross Hospital Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this author First published: 19 September 2007 https://doi.org/10.1111/j.1749-4486.2007.01484.xCitations: 77Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume32, Issue5October 2007Pages 411-412 RelatedInformation

Treatment of post-intubation laryngotracheal stenosis

Post-intubation laryngotracheal stenosis in children is an important therapeutic problem in pediatric otolaryngology. The numbers of children treated by prolonged intubation and resuscitated children are increasing. In the Department of Pediatric Otolaryngology in Warsaw, 6 children were treated for post-intubation laryngotracheal stenosis. In the treatment the method of longitudinal intralaryngotracheal incisions was applied; in 3 cases with tracheotomy followed by cellophane separation and in 3 cases without the use of separator and without tracheotomy. There were no complications connected directly with the operation. Pneumonia was a frequent later complication making treatment difficult. Good therapeutic results were obtained.