Postintubation Tracheal Stenosis Research Articles

Postintubation Tracheal Stenosis: Report of Two Cases and Literature Review

Tracheal stenosis (TS) is a well-recognized yet underdiagnosed complication of prolonged intubation. Mechanisms include tracheal injury during intubation and ischemia of tracheal mucosa at the site of the endotracheal tube cuff and resultant fibrotic stenosis. TS usually develops 3–6 weeks following extubation and is often misdiagnosed as bronchial asthma. We report two such cases who developed TS following prolonged intubation.

Outcomes of tracheal resection and anastomosis for post intubation tracheal stenosis: a study of 12 cases

Post intubation tracheal stenosis is a severe clinical condition with an increasing prevalence due to the advances of critical care medicine. This is a retrospective study including 12 cases of post-intubation tracheal stenosis managed by TRA in our head and neck surgery department between the years 2013 and 2019. All patients underwent preoperative clinical evaluation based on neck CT scan and endoscopy under general anaesthesia. Traffic road accidents and trauma were the main causes of prolonged intubation. Ten (10) patients required tracheostomy. According to the Cotton Meyer grading, 4 patients had grade II, 2 had grade III and 4 had grade IV. The mean length of stenosis was 16.2±5.6 millimeters. T-tube was inserted intraoperatively in 5 patients. 4 were successfully decannulated in a mean delay of 9.2 months. Early postoperative complications were subcutaneous emphysema, laryngeal edema, aspiration pneumonia, intra-tracheal migration of the T-tube, and vocal cord paralysis each complication occurred in 1 case. Late postoperative complications were granulation tissue formation observed in 5 cases and restenosis in 3 cases. The initial success rate of the TRA was 91.7%. Management of Post intubation tracheal stenosis requires a skillful multidisciplinary team. TRA guided by a meticulous preoperative evaluation is the gold standard. Keywords: tracheal resection, anastomosis, tracheal resection with end-to-end anastomosis, cervical computed tomography

Safety of Rigid Bronchoscopy for Therapeutic Intervention at the Intensive Care Unit Bedside.

Background and Objective: Although rigid bronchoscopy is generally performed in the operating room (OR), the intervention is sometimes emergently required at the intensive care unit (ICU) bedside. The aim of this study is to evaluate the safety of rigid bronchoscopy at the ICU bedside. Materials and Methods: We retrospectively analyzed medical records of patients who underwent rigid bronchoscopy while in the ICU from January 2014 to December 2020. According to the location of rigid bronchoscopic intervention, patients were classified into the ICU group (n = 171, cases emergently performed at the ICU bedside without anesthesiologists) and the OR group (n = 165, cases electively performed in the OR with anesthesiologists). The risk of intra- and post-procedural complications in the ICU group was analyzed using multivariable logistic regression, with the OR group as the reference category. Results: Of 336 patients, 175 (52.1%) were moribund and survival was not expected without intervention, and 170 (50.6%) received invasive respiratory support before the intervention. The most common reasons for intervention were post-intubation tracheal stenosis (39.3%) and malignant airway obstruction (34.5%). Although the overall rate of intra-procedural complications did not differ between the two groups (86.0% vs. 80.6%, p = 0.188), post-procedural complications were more frequent in the ICU group than in the OR group (24.0% vs. 12.1%, p = 0.005). Severe complications requiring unexpected invasive management occurred only post-procedurally and were more common in the ICU group (10.5% vs. 4.8%, p = 0.052). In the fully adjusted model, the ICU group had increased odds for severe post-procedural complications, but statistical significance was not observed (odds ratio, 2.54; 95% confidence interval, 0.73-8.88; p = 0.144). Conclusions: Although general anesthesia is generally considered the gold standard for rigid bronchoscopy, our findings indicate that rigid bronchoscopy may be safely performed at the ICU bedside in selective cases of emergency. Moreover, adequate patient selection and close post-procedural monitoring are required to prevent severe complications.

The critical period for development of secondary restenosis following post-intubation tracheal stenosis surgery

Background Determining a predictable duration to restenosis very essential for reducing mortality and morbidity for tracheal stenosis surgery. Objectives The aim of this study was to determine the critical periods for secondary restenosis risk for operated patients with post-intubation tracheal stenosis (PITS) during the initial healing period. Methods A total of 61 patients with a diagnosis of surgically treated PITS were included in the study. Treatment groups were carbon dioxide (CO2) laser and tracheal resection with primary anastomosis (TRPA). Duration to restenosis was compared with Kaplan–Meier curves between study groups. Results Restenosis developed in 11 (18.0%) patients and was diagnosed after a mean of 39.3 ± 38.5 (range, 22 to 155) days. Gender or Cotton–Myer grade of the PITS was not found to be risk factors for the development of stenosis. Restenosis rate was 33.3% in CO2 laser group and 10% in the TRPA group (p = .036). Duration to restenosis was detected at a median of 28 days in patients treated with CO2 laser, and a median of 30 days in patients treated with TRPA (p = .024). Conclusions The most critical period for the development of restenosis after PITS treatment is the third and fourth weeks, especially in patients treated with CO2 laser.

Relationship between etiology and morphological classification of benign central airway stenosis and its prognosis

Objectives: To analyze the relationship between etiology and morphological classification of benign central airway stenosis and its prognosis. Methods: We performed a retrospective study of the medical records of 453 patients initially diagnosed with benign airway stenosis at Department of Respiratory Diseases in Beijing Tiantan Hospital affiliated to Capital Medical University from January 2003 to October 2019. Of 453 patients, 260 were male. The age of the study population was 12-86(44.0±24.5) years. Results: Among the 453 patients diagnosed with benign central airway stenosis, 161 case (35.5%, including 113 post-tracheostomy tracheal stenosis and 48 post-intubation tracheal stenosis) were iatrogenic; 88 cases were from benign tumors (19.4%), 77 cases from tracheal or bronchial tuberculosis (17.0%), 71 case from tracheal foreign bodies (15.7%). Disease causes varied among different gender or age groups. The main type of stenosis was structural stenosis, of which 241 cases (53.2%) were intra-luminal and 183 cases (40.4%) were scar contracture type. The site of stenosis showed a certain relationship with the causes of stenosis. The stenosis degree was mainly from grade 2 to grade 4 (76.4%), and the length was mainly within 3 cm (84.8%). Single factor analysis on the relationship between disease cause, morphological classification and prognosis of benign central airway stenosis showed statistically better prognosis in groups that were caused by benign tumor, intraductal stenosis or stenosis that were 3-4 in degree and 1-2 degree in length. Conclusion: The common causes of central airway stenosis included iatrogenic stenosis, benign tumor, tracheal or bronchial tuberculosis and tracheal foreign bodies. Benign airway stenosis with different disease causes and morphological classification had different prognosis after bronchoscopic interventional treatment. Clinicians should know the disease causes, morphological characterization and risk factors for benign airway stenosis for earlier diagnosis, treatment or prevention.

Age-related difficulty in post-intubation tracheal stenosis reconstruction: a comparative analysis of CO2-laser, resection and anastomosis, and costal cartilage grafting techniques

BackgroundCostal cartilage graft (CCG) sustains primary donor material for laryngotracheal reconstruction in patients with post-intubation tracheal stenosis (PITS). But, the elasticity and viability of CCG decrease elderly. This study was aimed to examine the age factor in PITS cases according to the treatment groups, especially in the tracheal reconstruction surgery with CCG group.MethodsThis retrospective study was designed. Patients with a diagnosis of PITS were enrolled. The hazard ratio was calculated with the Cox regression model to define independent risk factors for failure among the variables.ResultsEighty-five patients diagnosed with post-intubation tracheal stenosis (PITS) were enrolled in the study. Restenosis developed in 19 (22.4%) patients. The failure rate in patients aged 40 years and older was 7.5 times higher on average compared to patients under 40 years of age (p = 0.004, 95% CI: 1.6–35.2). Additionally, age group ≥ 40 and CCG treatment group were a significant risk factors for surgical failure (p = 0.012, HR = 0.0003, 95% CI for HR = 0.0000006–0.173, and p < 0.001, HR = 0.001, 95%CI for HR = 0.000025–0.047, respectively).ConclusionsAge and CCG group were detected as independent risk factors for surgical failure, possibly due viability of costal cartilage.

Management of post intubation tracheal stenosis

Background: Postintubation tracheal stenosis (PITS) is caused by a number of etiologies demanding mechanical ventilation and application of endotracheal or tracheostomy tubes which in turn conflict regional ischemic necrosis of the airway at various levels, presenting the characteristic signs and symptoms of airway obstruction. The incidences of PITS have been decreased with the recognition of the causes, and modification of endotracheal tubes and methods of management. Patients and Methods: Fifty four patients were identified between June 2017 and June 2019. Those patients were treated for tracheal stenosis which developed after prolonged endotracheal intubation. The study was done in Cardiothoracic Surgery departments at Kasr-Alainy Hospital (Cairo University). Patients were managed by rigid bronchoscopic dilatation, airway devices (as Montgomery t-tube or metallic stent) and/or primary tracheal resection and end to end anastomosis. Results: Out of the 54 patients: Three (5.5%) were planned for tracheostomy from the start. Fifty-one (94.4%) were subjected to rigid bronchoscopic examination &amp; dilatation. Three patients (5.5%) were fully improved after bronchoscopic dilatation. The rest of the patients (48) were directed to the next stage in our management, either staged management or resection anastomosis.

Complex Post-intubation Tracheal Stenosis in Covid-19 Patients.

Management of tracheal complications due to endotracheal intubation in patients with coronavirus disease-2019 (COVID-19) is an important concern. This study aimed to present the results of patients who had undergone tracheal resection and reconstruction due to COVID-19-related complex post-intubation tracheal stenosis (PITS). We evaluated 15 patients who underwent tracheal resection and reconstruction due to complex PITS between March 2020 and April 2021 in a single center. Seven patients (46.6%) who underwent endotracheal intubation due to the COVID-19 constituted the COVID-19 group, and the remaining 8 patients (53.4%) constituted the non-COVID-19 group. We analyzed the patients’ presenting symptoms, time to onset of symptoms, radiological and bronchoscopic features of stenosis, bronchoscopic intervention history, length of the resected tracheal segment, postoperative complications, length of hospital stay, and duration of follow-up. Six of the patients (40%) were female, and 9 (60%) were male. Mean age was 43.3 ± 20.5. We found no statistically significant difference between the COVID-19 and non-COVID-19 PITS groups in terms of presenting symptoms, time to onset of symptoms, stenosis location, stenosis severity, length of the stenotic segment, number of bronchoscopic dilatation sessions, dilatation time intervals, length of the resected tracheal segment, postoperative complications, and length of postoperative hospital stay. Endotracheal intubation duration was longer in the COVID-19 group than non-COVID-19 group (mean ± SD: 21.0 ± 4.04, 12.0 ± 1.15 days, respectively). Tracheal resection and reconstruction can be performed safely and successfully in COVID-19 patients with complex PITS. Comprehensive preoperative examination, appropriate selection of surgery technique, and close postoperative follow-up have favorable results.

How long should it be insisted on rigid bronchoscopy in the treatment of postintubation tracheal stenosis in accordance with different stenosis classification systems?

Background In this study, we aimed to investigate the effectiveness of isolated rigid bronchoscopy used in the treatment of postintubation tracheal stenosis by its relationship with the most frequently used classifications, our own classification Stenosis Index, stenosis dimensions and its combinations. Methods Between March 2010 and July 2020, a total of 39 patients (16 males, 23 females; mean age: 41.5±20.7 years; range, 15 to 72 years) who had isolated rigid bronchoscopic dilation as a result of postintubation tracheal stenosis were retrospectively analyzed. The duration of treatment, the number of procedures, and the success of the treatment of patients were analyzed according to the most frequently used classifications and compared to our new classification. Results A statistically significant difference was found between the Stenosis Index groups in terms of the number of procedures and duration of treatment (p<0.01, p<0.01, respectively). No statistically significant differences were observed among the most frequently used classifications in terms of number of procedures and duration of treatment. The Stenosis Index classification groups most consistently reflected the success rate of the procedure, the number of procedures, the duration of the treatment and the rate of patients resected. Conclusion The Stenosis Index classification was considered to be a more effective parameter than the most frequently used classifications on the decision to give the patients with postintubation tracheal stenosis a chance to treat with bronchoscopic dilations procedure before resection.

Initial Experience of Endobronchial Silicon Stents from a Tertiary Care Centre in North India

Central airway obstruction (CAO) is defined as obstruction of trachea and principal bronchi. Therapeutic rigid bronchoscopy with tracheobronchial stenting using silicon stents is a well established procedure in the management of such conditions. However, there is limited experience with this technique in India. Between January 2010 and April 2010, Dumon stents were placed in four patients with CAO. Three patients had symptomatic tracheal stenosis while one patient had malignant obstruction at the carina. Rigid bronchoscopy under general anaesthesia was performed to relieve the CAO followed by placement of silicon stents. Pre- and post-stent placement symptom assessment was performed with a symptom-based visual analogue scale. Four patients underwent silicon stent placement in the tracheobronchial tree. Three patients had benign post-intubation tracheal stenosis and one had malignant tracheal obstruction at carina due to endobronchial growth. Significant improvement was achieved in all patients. There were no significant complications. Rigid bronchoscopy with silicon stent placement is an effective and suitable method of relieving the distressing symptoms due to benign or malignant airway obstruction.

COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?

During the current pandemic, we witnessed a rise of post-intubation tracheal stenosis (PITS) in patients intubated due to COVID-19. We prospectively analyzed data from patients referred to our institution during the last 18 months for severe symptomatic post-intubation upper airway complications. Interdisciplinary bronchoscopic and/or surgical management was offered. Twenty-three patients with PITS and/or tracheoesophageal fistulae were included. They had undergone 31.85 (±22.7) days of ICU hospitalization and 17.35 (±7.4) days of intubation. Tracheal stenoses were mostly complex, located in the subglottic or mid-tracheal area. A total of 83% of patients had fracture and distortion of the tracheal wall. Fifteen patients were initially treated with rigid bronchoscopic modalities and/or stent placement and eight patients with tracheal resection-anastomosis. Post-treatment relapse in two of the bronchoscopically treated patients required surgery, while two of the surgically treated patients required rigid bronchoscopy and stent placement. Transient, non-life-threatening post-treatment complications developed in 60% of patients and were all managed successfully. The histopathology of the resected tracheal specimens didn’t reveal specific alterations in comparison to pre-COVID-era PITS cases. Prolonged intubation, pronation maneuvers, oversized tubes or cuffs, and patient- or disease-specific factors may be pathogenically implicated. An increase of post-COVID PITS is anticipated. Careful prevention, early detection and effective management of these iatrogenic complications are warranted.

Outcome of Post-intubation Tracheal Stenosis (PITS) with Primary Resection and Anastomosis.

To ascertain the outcome of primary resection anastomosis in patients of post-intubation tracheal stenosis (PITS) and the associated morbidity. A case series. Department of Thoracic Surgery, Combined Military Hospital, (CMH) Rawalpindi, Lahore and Multan from January 2010 to August 2018. Patients with tracheal stenosis due to prolonged intubation with functional were included. Exclusion criteria were patients having stenosis due to malignant cause, trauma and glottic stenosis involving vocal cords. Clinical examination, computerised tomography (CT) of neck plus chest and fiberoptic bronchoscopy were done in all the patients, while virtual bronchoscopy were done in 35 cases. Sharp dissection, aided by loupes, was the preferred technique. Thyroid tissue and strap muscle were used as flap for high cricoid lesion. Guardian stitch was applied to all cases. Postoperative elective bronchoscopy was performed after a fortnight. Among 43 patients, [26 (60.5%) men and 17 (39.5) women] 18 patients were intubated for days >10 ,18 for <10 and 7 for <3 days. Thirty-four (79.1%) patients were under 40 years of age, while 23 patients had tracheostomy incorporated in surgery. Bronchoscopy evaluation of distance from vocal cords showed involvement of the first ring in six patients, 1st ring normal in 1, 2 rings normal in 17, while 3 or more rings spared in 19 patients. Length of stenotic segment was <2 cm in 17, between 2-3 cm in 21, and between 3-5 cm in five patients. All patients were successfully extubated. Two patients had twin lesions. Seven patients required hyoid bone excision and release. There was one recurrent stenosis managed successfully with dilatation and granulation removal. Post-intubation tracheal stenosis (PITS) is curable disease. Primary resection and anastomosis remain the gold standard with acceptable morbidity and mortality. Key Words: Tracheal stenosis, Intubation, Resection, Primary anastomosis.

Treatment Results and Postoperative Complications of Single-Stage Tracheal Resection in Adolescent Patients with Post-Intubation Tracheal Stenosis, Compared to Adults.

Objective:The purpose of this study was to analyze the treatment outcomes and postoperative complications of tracheal resection in patients under the age of 19 years with post-intubation tracheal stenosis, and to compare the results with those of adults.Methods:Data were retrospectively retrieved from the medical records, including demographic characteristics, perioperative features, any postoperative complications and follow-up statuses of the patients. Treatment results and postoperative complications were compared between adolescent and adult groups.Results:Overall, anastomotic and non-anastomotic complication rates in the adolescent group and the adult group were 40%, 40%, 10% and 63%, 44.4%, 33.3%, respectively. Overall treatment success rates based on tracheostomy tube and tracheal stent free status were 90% and 92.6% in adolescent and adults, respectively.Conclusion:Treatment success rates and incidence of anastomotic complications were found similar in patients under the age of 19 years and adult patients who underwent single-stage tracheal resection and end to end anastomosis for treatment of post-intubation tracheal stenosis.

On the possibility of photodynamic inactivation of tracheobronchial tree pathogenic microbiota using methylene blue (in vitro study)

BackgroundThe treatment of patients after mechanical ventilation of lungs suffering from a multi-species infection of the tracheobronchial tree can be complicated.. The situation is aggravated in patients with post-intubation tracheal stenosis, where infection plays a leading pathogenetic role in damage to the tracheal wall. As a result of such a pathological process, cicatricial stenosis of the trachea of purulent-inflammatory infectious genesis or infected tracheal stenosis (ITS) may occur. MethodsIn this work, we studied the possibility of photodynamic inactivation of pathogenic microbiota typical for patients with ITS using methylene blue (MB) as a photosensitizer. Results13 clinical isolates of 8 species of bacteria from 9 patients were susceptible to photodynamic inactivation with MB. 30 μM of MB at a light irradiation dose of 25 J/cm2 and incubation with MB for 15 min allows to completely inactivate bacteria found in the tracheobronchial secretions of patients with ITS. ConclusionsMB retains its optico-physical properties in the range of 3–30 μM and provides effective inactivation of isolated Gram-positive and Gram-negative bacteria, including multi- and pan-resistant to antibiotics.

Post-intubation tracheal stenosis in pediatric age group: single-center experiences of 24years.

Post-intubation tracheal stenosis (PITS) is an iatrogenic injury that involves some patients. Given the importance of this issue and the referral of a significant number of children with tracheal stenosis to Masih Daneshvari Hospital in Tehran, Iran, the present study investigated tracheal stenosis following prolonged intubation in the pediatric age group. In this observational retrospective study, from 1994 to 2018, the medical records of all children under 14years of age with a history of PITS were reviewed. Demographic and clinical characteristics including signs and symptoms, the underlying condition that leads to intubation, duration of intubation, type of stenosis, and the therapeutic approach, type of surgery, and follow-up were collected and analyzed using SPSS. Among 161 patients with a mean age of 9.8 ± 4.2years, 69% were male. The site of stenosis was limited to the trachea in 47% and others both trachea and subglottic area were involved. The most common cause of intubation was trauma. The most common symptoms were dyspnea and wheezing. Success rates of reconstruction were 93.75% in type I, 82.15% in type II, and 35.70% in type III. Among the 16 patients who underwent Type III surgery, decannulation was not performed in 11 patients. Traction in the anastomosis and complications were stated in 26 and 10% of the patients respectively, a mortality rate of 8.7% was also reported. In the case of endotracheal intubation, PITS should be considered in the differential diagnosis of dyspnea in children as well as adults.

Prognostic Factors for Tracheal Restenosis after Stent Removal in Patients with Post-Intubation and Post-Tracheostomy Tracheal Stenosis.

PurposeLong-term tracheal stent placement can increase the risk of stent-related complications; hence, removal of the stent after stabilization is attempted. However, little evidence has been established regarding the risk factors for tracheal restenosis. We aimed to identify the risk factors for tracheal restenosis in patients with post-intubation tracheal stenosis (PITS) and post-tracheostomy tracheal stenosis (PTTS).Materials and MethodsWe retrospectively analyzed patients with PITS and PTTS between January 2004 and December 2019. Patients were classified into a success or failure group according to treatment outcomes. Patients with successful stent removal were defined as patients who did not require additional intervention after stent removal during the follow-up period. Multiple logistic regression analysis was performed to identify the factors associated with tracheal restenosis.ResultsAmong 269 stented patients, 130 patients who had removed the stent were enrolled in this study. During the follow-up period, 73 (56.2%) patients had a stable clinical course; however, 57 (43.8%) patients had restenosis. The proportion of trauma-induced intubation was higher in the success group than in the failure group (p=0.026), and the median stent length was shorter in the success group (45 mm) than in the failure group (50 mm, p=0.001). On multivariate analysis, trauma-induced intubation [adjusted odds ratio (aOR), 0.329; 95% confidence interval (CI), 0.117–0.927; p=0.036], and stent length <50 mm (aOR, 0.274; 95% CI, 0.130–0.578; p=0.001) were associated with a decreased risk of restenosis.ConclusionTrauma-induced intubation and stent length were associated with successful stent removal.

Surgical management of patients with post-entubation tracheal stenosis (PETS): A single center experience

Post-entubation tracheal stenosis(PETS) is observed in patients who are hospitalized in the intensive care unit due to various etiological reasons and who are exposed to prolonged intubation during follow-up as a result of the pressure applied to the tracheal mucosa to cause necrosis or scarring in the trachea. In our study,we aimed to retrospectively evaluate the results of patients who underwent dilatation with rigid bronchoscopy and those whose conditions did not improve despite dilatation and underwent tracheal resection and reconstruction, and compare the with the literature. This study was conducted to retrospectively analyze the data of 20 patients who underwent surgical intervention due to PETS between 2019-2022.The patients were divided into 2 groups according to the Cotton Myer PETS index of the data obtained as a result of measuring the diameter of the stenotic tracheal segment according to bronchoscopic and CT measurements. When the patients were classified according to the post-intubation tracheal stenosis classification described by Cotton Myer,it was seen that 7 patients were Grade 1.10 patients were Grade 2 and 3 patients were Grade 3. Tracheal resection and reconstruction surgery is a difficult procedure and requires surgical experience due to the lack of experienced anesthesia team in every center.For this reason,we recommend sequential bronchoscopic dilatation in patients with comorbidity who are not suitable for tracheal resection and in grade 1 patients. However, we suggest that tracheal resection and reconstruction surgery should be performed after appropriate preoperative preparation in patients with grade 2 and 3 without comorbidity.

Efficacy and safety of Montgomery T-tube placement for benign complex subglottic tracheal stenosis: a retrospective analysis of 29 cases

Objective: To analyze the efficacy and safety of Montgomery T-tube (T-tube) placement for benign complex subglottic tracheal stenosis. Methods: A retrospective analysis of the clinical data of 29 patients with benign complex subglottic tracheal stenosis receiving T-tube placement in Beijing Tiantan Hospital from May 2015 to December 2019. The causes were postintubation tracheal stenosis [27 cases (93.1%), including 21 cases (72.4%) of tracheal stenosis after tracheotomy, 6 cases (20.7%) of tracheal stenosis after tracheal intubation], cervical post-traumatic tracheal stenosis (1 case, 3.4%) and tuberculous tracheal stenosis (1 case, 3.4%), respectively. Three-dimensional reconstruction of tracheal computerized tomography (CT) and bronchoscopy were used to grade the stenosis according to Cotton-Myer classification system before bronchoscopic intervention. The degree of stenosis was Cotton-Myer grade Ⅱ (7 cases, 24.1%), grade Ⅲ (11 cases, 37.9%) and grade Ⅳ (11 cases, 37.9%), respectively. All cases received placement of T-tubes and follow-up. Fisher's exact test was used for comparison between groups. Results: T-tube placement was performed 39 times in 29 patients. T-tubes were successfully placed for 24 cases (82.8%). The main complication during the operation was tracheal mucosal tear (6 cases, 20.7%), which resolved in all cases within 2 weeks. The main postoperative complication was secretion retention (27 cases, 93.1%), which was relieved after home nebulization treatment in 26 cases; and followed by granulation hyperplasia, especially located in T-tube upper margin (12 cases, 41.4%), of which 8 cases were cured after bronchoscopic intervention. None of the patients had T-tube migration. There were no statistically significant differences in the success rate of T-tube placement and the incidence of major complications in patients with benign complex subglottic tracheal stenosis with different degrees of stenosis. After 18 months to 24 months of follow-up, attempt was made to remove the T-tube in 9 patients but failed in 4 patients. The failure was due to collapse of the airway after the T-tube was removed. Conclusion: T-tube placement is a safe and reliable treatment for benign complex subglottic tracheal stenosis with high efficiency and manageable complications.

Endobronchial intubation in tracheal stenosis: An uncommonly reported complication

Tracheal stenosis is a life-threatening condition resulting from various causes like congenital, postintubation injury, trauma, inhalational burns, irradiation, tracheal tumor, extrinsic compression of trachea by tumor and idiopathic [1]. Though the exact prevalence is unknown, the estimated incidence of postintubation tracheal stenosis is 4.9 cases per million per year [2]. Airway management of patient with previously undiagnosed tracheal stenosis after induction of anaesthesia is a challenging task. Airway management of tracheal stenosis is commonly complicated by failure of passage of endotracheal tube (ETT), but our case was perplexed by occurrence of left sided endobronchial intubation.

Stenoza de trahee postintubațională – o cauză rară de dispnee

Tracheal stenosis is a rare complication of tracheal intubation, which usually becomes symptomatic after some time after detubation, with typical superior airway obstruction signs and symptoms. This is a case of a 62-yearold female with post intubation tracheal stenosis, with interesting problems of differential diagnosis until the final diagnostic was found. Clinical and imagistic investigations led us to our final diagnosis of iatrogenic post intubation tracheal stenosis.