Postintubation Tracheal Stenosis Research Articles

Post-intubation tracheal stenoses: what is the curative yield of the interventional pulmonology procedures?

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FEATURES OF INTENSIVE TREATMENT IN PATIENTS AFTER TRACHEOSTOMY

Objective: to enhance the efficiency of medical rehabilitation in patients who have undergone mechanical ventilation (MV) and tracheostomy in an intensive care unit through dynamic clinical, laboratory, endoscopic control and adequate therapy for detected pathology. A total of 120 intensive care unit patients who had undergone tracheostomy in different MV periods were examined. Subjects and methods. A total of 120 patients (76 men and 44 women) aged 15 to 78 years were examined in different MV periods. All the patients were operated on in intensive care units. The surgical techniques of tracheostomy were described; the clinical and endoscopic pattern of the laryngeal and tracheal mucosa in patients on MV was presented. The bacteria isolated from the patients on MV were typed; the cartilages of the anterior tracheal wall were pathomorphologically studied in different MV periods. Results. Microbiological examination indicated the predominance of the mixed microflora: Staphylococcus, Pseudomonas aeruginosa and Proteus. Intraoperative postmortem examination of the cartilages of the anterior tracheal wall was made in 30 patients in different MV periods who were noted to develop pathological changes in the laryngeal and tracheal mucosa and destructive and dystrophic alterations in the tracheal cartilage even if their intubation lasted as long as 3 days. Morphological examination of tracheal cartilages in patients who were on MV for 4 to 7 days revealed progressive destructive and dystrophic processes in peretracheal connective tissue, leukocyte accumulation, and focal bleeding. During intubation for more 7 days, there was partial death of the cartilage, its replacement by granulation tissue, and appearance of regions of sequestration of the dead cartilage. Endoscopic examination showed varying degrees of postintubation laryngeal and tracheal changes in all (n=120) the examinees. Conclusion. The performed treatment permitted decannulation of 111 patients; 16 patients underwent endoscopic intervention into the larynx and trachea; reconstructive operations followed by decannulaton were performed in 4 patients with postintubation laryngeal and tracheal stenosis; 5 patients with severe comorbidity remained to be chronic cannula carriers.

Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy

Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis.

Failed intubation of an unanticipated postintubation tracheal stenosis: a case report.

Encountering a patient with unanticipated laryngotracheal stenosis (LTS) during anesthetic induction is challenging for an anesthesiologist. Because routine history taking and pre-anesthetic evaluation cannot rule out the possibility of LTS, other measures should be taken. Perioperative airway maintenance is considered crucial for avoiding complications such as airway edema, bleeding, obstruction, collapse, and ultimately respiratory failure and arrest. We report an unanticipated tracheal stenosis discovered during anesthetic induction that hindered endotracheal intubation. Because airway maintenance was difficult, we postponed surgery until determining the cause of the difficult entry, considered possible therapeutic approaches (both anesthetic and surgical), and provided successful surgery with a continuous epidural block.

Fully Covered Metallic Stents for the Treatment of Benign Airway Stenosis.

Introduction. We herein report our experience with new fully covered self-expanding metallic stents in the setting of inoperable recurrent benign tracheobronchial stenosis. Methods. Between May 2010 and July 2014, 21 Micro-Tech® FC-SEMS (Nanjing Co., Republic of Korea) were placed in our hospital in 16 patients for inoperable, recurrent (after dilatation), and symptomatic benign airway stenosis. Their medical files were retrospectively reviewed in December 2014, with focus on stent's tolerance and durability data. Results. Twenty-one stents were inserted: 13 for posttransplant left main bronchus anastomotic stricture, seven for postintubation tracheal stenosis, and one for postlobectomy anastomotic stricture. Positioning was easy for all of them. Stents were in place for a mean duration of 282 days. The most common complications were granulation tissue development (35%), migration (30%), and sputum retention (15%). Fifty-five % of the stents (11/20) had to be removed because of various complications, without difficulty for all of them. None of the patients had life-threatening complications. Conclusion. Micro-Tech FC-SEMS were easy to position and to remove. While the rate of complications requiring stent removal was significant, no life-threatening complication occurred. Further studies are needed to better define their efficacy and safety in the treatment of benign airway disease.

Management of Post-intubation and/or Tracheotomy Tracheal Stenoses

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Iatrogenic airway injury

### Key points While most anaesthetists use airway devices on a daily basis without apparent complication, they should always be aware of the possibility of injury. Knowledge of these injuries aids prevention and allows timely diagnosis and correct treatment. In this article, we summarize injuries reported from common airway interventions with particular focus on post-intubation tracheal stenosis (PITS). Allergic and irritant type reactions are much less common with single-use face masks than with reusable masks, especially where chemical disinfectants are used in the cleaning process. Soft tissue injuries such as abrasions and ulcers are possible in anaesthetic practice. However, now that prolonged face mask anaesthesia is uncommon, they are more likely to be observed in patients receiving non-invasive ventilation or continuous positive airway pressure. The eye is particularly vulnerable to contact with a face mask and corneal abrasions are possible unless a correctly sized mask is used and continued care is taken. Serious harm from the use of face masks is uncommon and appears to be caused mainly by excessive pressure. This can result either from the face mask itself or from the anaesthetist's hands when performing a jaw thrust manoeuvre and can result in sensory change to the face from pressure to the mental nerve. Likewise pressure to the mandibular branch of the facial nerve can result in paralysis of the muscles of the lower lip and chin. These examples of neuropraxia are rare, occurring only in …

Successful treatment of post-intubation tracheal stenosis with balloon dilation, argon plasma coagulation, electrocautery and application of mitomycin C

Tracheal stenosis is an uncommon but known complication of endotracheal intubation and tracheostomy. Surgery is currently the definitive treatment for tracheal stenosis but carries a significantly higher risk for adverse events as it often involves complex procedures. Here we present our experience using topical application of mitomycin C, along with various bronchoscopic interventions, as a treatment for tracheal stenosis. The patients in our series developed tracheal stenosis post-intubation or post-tracheostomy. Each patient in our series underwent the same basic procedures involving rigid bronchoscopy and balloon dilation, ablation of granulation tissue with cryotherapy and argon plasma coagulation, and finally application of topical mitomycin C. Our experience with these four cases shows a good initial success rate with topical mitomycin C application for the treatment of tracheal stenosis. Most patients required a repeat intervention a few weeks later. Our results suggest that success with topical mitomycin C is more likely in post-intubation rather than post-tracheostomy tracheal stenosis. Bronchoscopic therapy and topical application of mitomycin C may work better as a bridge to definitive surgery rather than as a stand-alone therapy.

Successful treatment of post-intubation tracheal stenosis with balloon dilation, argon plasma coagulation, electrocautery and application of mitomycin C

Successful treatment of post-intubation tracheal stenosis with balloon dilation, argon plasma coagulation, electrocautery and application of mitomycin C

Cytokines and Defensins in Tissue Biopsies Obtained by Bronchoscopy from Patients with Post-Intubation Tracheal Stenosis

Aims: The objective of our study was to perform the routine analysis of bronchoscopically obtained tracheal samples to determine the appearance and relative distribution of cytokines and antimicrobial proteins in patients with post-intubation tracheal stenosis (PITS). Study Design: Retrospective. Place and Duration of Study: Rīga Stradiņo University, Institute of Anatomy and Anthropology, Pauls Stradiņo Clinical University Hospital, between May 2014 and May 2015. Methodology: Five patients with PITS were involved in this study. Tissue samples were obtained by bronchoscopy from the upper part of trachea, then proceeded for routine histological staining with hematoxylin and eosin. Interleukine-1 (IL-1), interleukine-10 (IL-10) and tumor necrosis factor alpha (TNF α), as well as beta defensin-2 ( β def-2) were detected by use of immunohistochemistry (IMH) method. The number of immunoreactive (positive) structures was graded semi-quantitatively.

Tracheal Resection and Anastomosis for Postintubation Tracheal Stenosis

Introduction: Tracheal stenosis is one of the dreaded complication of tracheal intubation. Tracheal resection and anastomosis is an established definitive treatment for stenosis more than one cm. Here, we present a case of postintubation tracheal stenosis managed by resection and anastomosis, first of its kind in our centre.
 Case Report: We present a case of 26-year female who underwent tracheal intubation during her treatment of tubercular meningitis. Two weeks later, she returned with respiratory difficulty. A diagnosis of post-intubation tracheal stenosis was made. Tracheal resection and anastomosis was done. Recovery was uneventful and she was discharged on 14th post-operative day.
 Conclusion: Post-intubation tracheal stenosis is still a dreaded complication even after the introduction of high volume low pressure cuff. They can be successfully managed. Care personnel in intensive care unit (ICU) should perform to prevent this complication.

Multidetector CT evaluation of airway stents: what the radiologist should know.

Airway stents are increasingly used to treat symptomatic patients with obstructive tracheobronchial diseases who are not amenable to surgical resection or who have poor performance status, precluding them from resection. The most common conditions that are treated with tracheobronchial stents are primary lung cancer and metastatic disease. However, stents have also been used to treat patients with airway stenosis related to a variety of benign conditions, such as tracheobronchomalacia, relapsing polychondritis, postintubation tracheal stenosis, postoperative anastomotic stenosis, and granulomatous diseases. Additionally, airway stents can be used as a barrier method in the management of esophagorespiratory fistulas. Many types of stents are available from different manufacturers. Principally, they are classified as silicone; covered and uncovered metal; or hybrid, which are made of silicone and reinforced by metal rings. The advantages and disadvantages of each type of airway stent are carefully considered when choosing the most appropriate stent for each patient. Multidetector computed tomography plays an important role in determining the cause and assessing the location and extent of airway obstruction. Moreover, it is very accurate in its depiction of complications after airway stent placement.

Successful Treatment of Postintubation Tracheal Stenosis With Balloon Dilation, AOC Electrocautery, and Application of Mitomycin C

Successful Treatment of Postintubation Tracheal Stenosis With Balloon Dilation, AOC Electrocautery, and Application of Mitomycin C

To breathe or not to breathe: a review of artificial airway placement and related complications.

Artificial airway devices are commonly used to provide adequate ventilation and/or oxygenation in multiple clinical settings, both emergent and nonemergent. These frequently used devices include laryngeal mask airway, esophageal-tracheal combitube, endotracheal tube, and tracheostomy tube and are associated with various acute and late complications. Clinically, this may vary from mild discomfort to a potentially life-threatening situation. Radiologically, these devices and their acute and late complications have characteristic imaging findings which can be detected primarily on radiographs and computed tomography. We review appropriate positioning of these artificial airway devices and illustrate associated complications including inadequate positioning of the endotracheal tube, pulmonary aspiration, tracheal laceration or perforation, paranasal sinusitis, vocal cord paralysis, post-intubation tracheal stenosis, cuff overinflation with vascular compression, and others. Radiologists must recognize and understand the potential complications of intubation to promptly guide management and avoid long-term or even deadly consequences.

Computed tomography imaging feature of post-intubation tracheal stenosis and its clinical significance

Computed tomography imaging feature of post-intubation tracheal stenosis and its clinical significance

Tracheal stenosis after intubation and/or tracheostomy

IntroductionThe tracheal iatrogenic stenosis remains a frequent, sometimes severe tracheal resection, anastomosis is the treatment of choice. However, the endoscopic treatment is used as an alternative therapy. Materials and methodsWe report a retrospective study for a period of 8years. Results174 patients had an iatrogenic tracheal stenosis of intubation (55.17%) and/or tracheotomy (44.82%).The appearance and extent of stenosis were assessed by bronchoscopy, we noted a tracheal malacia (15%), a circumferential stenosis (58%), a little tight stenosis (12%) and diaphragm (5%).Some patients have benefited from several therapeutic procedures, 90 patients were operated on early interventions with 53 and 37 after surgery, an improvement of the patient’s clinical status have been postponed earlier, after failure of endoscopic methods. 293 interventional bronchoscopies were performed, 192 stenting, 45 Nd-YAG laser, 55 patients required a recalibration in the tube of the bronchoscope and one patient received cryotherapy, knowing that there are the patients who received combination therapy. We lamented death in the immediate postoperative sepsis, a recurrence of stenosis in 117 patients, and among the 192 implants placed we identified 37 migrations, 52 congestion, development of granulomatous lesions, an overhaul of the prosthesis is noted in 7.29%, three implants were embedded in the tracheal mucosa and there was only one spontaneous rejection. The long-term evolution was satisfactory in 92 patients. ConclusionNevertheless, the management of post intubation tracheal stenosis and/or post tracheostomy cannot be that requiring a multidisciplinary collaboration.

Topical application of mitomycin-C as an adjuvant treatment to bronchoscopic procedures in post-intubation tracheal stenosis

IntroductionPost-intubation tracheal stenosis (PITS) continues to be challenging in terms of diagnosis, management and prevention. Recurrence is common because of excessive granulation tissue formation and an insidious process of scar contracture. Topical application of mitomycin-C (MMC) as an adjuvant treatment for endoscopic management of stenosis has shown good results. The authors aimed to evaluate the results of MMC topical application following bronchoscopic dilatation as an adjuvant in PITS treatment. MethodsRetrospectively selected patients with PITS who had had rigid bronchoscopy (RB) dilatation followed by MMC application as adjuvant to endoscopic treatment. MMC in a concentration of 0.4mg/ml was applied with a cotton stiletto around the stenotic lesion and granulation tissue for 3min. ResultsEleven patients with PITS, with a median initial tracheal stenosis of 75% of the lumen, underwent RB/MMC treatment. Mean MMC sessions performed/patient was 3.5, with good response and prolonged decrease in granulation tissue formation in 55% of cases, moderate in 18% and relapse in 27%. Mean stenosis improvement was 34%. ConclusionsTopical MMC application at 0.4mg/ml concentration seems to be associated with good results as adjuvant in PITS management with decrease in granulation tissue and sustained improvement in lumen diameter.

Novel insights into the role of hypoxia-inducible factor-1 in the pathogenesis of human post-intubation tracheal stenosis

Hypoxia is an important mechanism involved in dermal scar formation. Post-intubation tracheal stenosis (PTS) has similar pathological characteristics and formation mechanisms to skin hypertrophic scars. Hypoxia-inducible factor‑1α (HIF‑1α) is a nuclear transcription factor that facilitates the adaptation of human cells to compromised oxygen tension under hypoxic conditions. The aim of this study was to investigate whether hypoxia and HIF-1α were involved in PTS. In the first part of our study, we observed the effects of tracheal mucosal pressure exerted by the endotracheal tube cuff and duration of intubation on tracheal stenosis using prospective methods. In the second part of our study, 24 patients were divided into three groups, according to the characteristics observed using bronchoscopy: granulation phase group, proliferative phase group and mature phase group. Tissues showing dysplasia were obtained using bronchoscopy forceps, and western blotting was performed to detect the protein expression of HIF-1α and its target genes, including vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and transforming growth factor (TGF)-β. In experiment one, we observed that the tracheal mucosal pressure exerted by the endotracheal tube cuff in the PTS group was significantly higher compared with that in the group without PTS, and the duration of intubation was longer compared with that in the group without PTS (P<0.05). In experiment two, we observed that the expression of HIF-1α was highest in the granulation phase, showed a decrease in the proliferative phase and in the mature phase was significantly reduced compared with the other two phases. The results were similar for VEGF and bFGF. TGF‑β protein expression was highest in the proliferative phase, significantly reduced in the mature phase and the same trends were observed for collagen type Ⅰ and III, and α-smooth muscle actin. HIF-1α is involved in the pathogenesis of PTS and may be a potential key regulator in the initiation and facilitation of this process.

Le rôle de la prothèse endotrachéale en silicone dans la sténose trachéale post-intubation

Le rôle de la prothèse endotrachéale en silicone dans la sténose trachéale post-intubation

Rôle de la réhabilitation respiratoire dans la prise en charge multidisciplinaire d’un patient avec sténose trachéale post-intubation et BPCO

Rôle de la réhabilitation respiratoire dans la prise en charge multidisciplinaire d’un patient avec sténose trachéale post-intubation et BPCO