Presence Of Tracheomalacia Research Articles

Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis.

Peristomal subglottic stenosis (SGS) is a common sequela after tracheostomy, with severe cases precluding decannulation. Predictors of decannulation success in these patients following endoscopic intervention are not well studied. The aim of this study is to investigate predictors of successful decannulation and inform treatment decisions. This study is a retrospective case series of 22 adult patients presenting to the senior author with a tracheostomy and peristomal SGS precluding decannulation between 2018 and 2023. Department of Otolaryngology-Head & Neck Surgery, University of Arizona College of Medicine-Tucson. Patient demographics, relevant clinical factors, stenosis characteristics, and the number of endoscopic procedures performed were analyzed to identify predictors of successful decannulation. Endoscopic interventions were generally performed 3 months apart with CO2 laser debridement, balloon dilation, and intralesional injection of steroid, all done with a laser-safe endotracheal tube in place through the stoma. Out of the 22 patients in the study, 9 (40.9%) achieved decannulation, all through an endoscopic approach. Body mass index (BMI) and age were identified as significant negative predictors of decannulation success (P = .02; P = .05, respectively). Stenosis characteristics, such as the presence of tracheomalacia, excessive dynamic airway collapse, multilevel stenosis, posterior glottic stenosis, and anterior granulation tissue shelf did not significantly impact decannulation success. A 40.9% decannulation rate was achieved in our cohort. BMI and age were identified as negative predictors of decannulation success. Stenosis characteristics did not significantly affect decannulation outcomes. Further investigation is warranted to establish reliable predictors of decannulation.

Predictors of response to endoscopic management of subglottic/tracheal stenosis in patients without tracheostomy

IntroductionSubglottic and tracheal stenosis (SGTS) in adults is an acquired or idiopathic condition that can lead to dyspnea, and even life-threatening airway obstruction. Endoscopic techniques have advanced and largely eclipsed open surgery, with open surgery now reserved for refractory cases (Hseu et al., 2013; Feinstein et al., 2017). Currently, there is no accepted guideline for the endoscopic treatment of SGTS. Thus, the aim of the present study is to examine the impact of various clinical and pathological characteristics on outcomes to endoscopic treatment in a cohort of SGTS patients. DisclosureNone of the authors have any financial or personal relationship that could cause a conflict of interest regarding this article. MethodsRetrospective chart review was performed for 41 patients presenting with SGS without a tracheostomy over a 4-year-period (2018–2022), within a single tertiary care center. Quantitative outcomes including number of dilation procedures undergone and need for open procedures were examined. The qualitative variables included a history of pulmonary disease, prior tracheostomy/tracheal resection, presence of tracheomalacia, granulation tissue, excessive dynamic airway collapse (EDAC), and etiology of idiopathic subglottic stenosis. ResultsThe presence of granulation tissue seen on tracheoscopy was associated with a higher number (4+) of dilation procedures (p = 0.01). A history of pulmonary disease (p = 0.037), the presence of tracheomalacia (p = 0.039), and the presence of granulation tissue (0.003) were all associated with a need for open procedures. ConclusionPatients with the presence of granulation tissue, tracheomalacia, and a history of pulmonary disease were more associated with more severe disease requiring either a higher number of endoscopic procedures or need for open procedures.

Outcomes of pediatric tracheostomy after surgery for congenital heart disease: A 20-year experience.

Children with congenital heart defects (CHD) requiring cardiovascular surgery (CVS) rarely require tracheostomy placement; however the mortality rate remains high. The study aimed to analyze the incidence of tracheostomy in children with CHD, and to determine factors contributing to postoperative outcomes, decannulation rates, and mortality. Retrospective case series of children ≤18 years old with CHD status post-CVS who underwent tracheostomy placement between January 1, 2001 and December 31, 2020. Variables analyzed included demographic information, presence of comorbidities including prematurity, respiratory diseases, presence of genetic syndromes, decannulation status, type of repair (univentricular vs. biventricular), and need for cardiopulmonary bypass. Adverse events analyzed included all-cause mortality, development of mediastinitis, fatal decannulation, and persistence of tracheocutaneous fistula. Fifty-one patients were analyzed. The incidence of tracheostomy was 0.8%. Median age at tracheostomy was 5.3 months. The 5-year survival estimate was 56.3% (95% confidence interval 43.6%, 72.6%). Age ≤6 months at the time of tracheostomy placement (p = .03), and the presence of tracheomalacia (p = .04) were factors significantly associated with 5-year survival. Two patients (3.9%) experienced fatal decannulation, and one patient (2.0%) developed postoperative mediastinitis. The 10-year decannulation rate estimate was 47.8% (30.5%, 63.2%). Seven patients (13.7%) had a persistent tracheocutaneous fistula. This study corroborates high mortality rates in this population. Factors associated with improved survival were younger age at the time of tracheostomy and presence of tracheomalacia. Decannulation rates were low, but estimates improved over 10 years. Further studies are needed to determine optimal indications and timing for tracheostomy placement in this patient population. 4.

Лечение рубцовых стенозов трахеи после ларингэктомии

The aim of the research. To evaluate the results of treatment of patients with cicatricial tracheal stenosis after laryngectomy. Material and methods. A total of 15 patients with cicatricial tracheal stenosis (CTS) and persistent tracheostomy after laryngectomy for laryngeal cancer were treated. The treatment employed an algorithm including bougienage, cryodestruction and stenting, as well as complex bronchodilator therapy aimed at restoring bronchial patency. Cryotherapy of CTS was performed through a tracheostomy with a developed cryoapplicator made of titanium nickelide. Results. The duration of cannula-bearing period after tracheal stenosis was from six months to three years. The length of cicatricial changes ranged from 10 to 55 mm. Tracheal stenosis was detected in the area of the end tracheostomy in 10 patients, at the level of the thoracic trachea in 4 patients, subtotal tracheal injury after laryngectomy in 1 patient. Subcompensated tracheal stenosis was detected in 10 patients, decompensated – in 5, of which 2 patients had this condition combined with tracheomalacia. In case of decompensated stenosis, emergency bougienage of the trachea was performed. Recanalisation and maintenance of the tracheal lumen was carried out according to the proposed treatment regimen. No fatal outcomes were registered during the hospitalisation period. All patients managed to restore adequate breathing and tracheal lumen. Within 6-8 months, 12 patients were decannulated, the rest continued cannula-bearing and free breathing was supported by stenting. The failure of their decannulation was associated with the presence of tracheomalacia and subtotal tracheal stenosis. Conclusion. Surgical correction of CTS in patients after laryngectomy requires an alternative therapeutic approach and differs from those prescribed in the classical version of stenosis. The proposed CTS treatment after extirpation of the larynx is an effective method for restoring the patency of the airways, allowing 80% of patients to restore free breathing without a tracheostomy cannula. The use of the adapted cryoapplicator made of titanium nickelide expands the possibilities of cryosurgery, and the developed method of CTS treatment may be recommended for wide practical application.

DOZ047.49: Tracheoscopic findings and their impact on respiratory symptoms in children with esophageal atresia

Introduction Esophageal atresia is often accompanied by tracheobronchial malformations leading to stridor, recurrent bronchitis and occasionally to life threatening obstructive apnea after surgical repair. The aim of this study was to identify the presence of tracheomalacia in patients with esophageal atresia (EA) and tracheo-esophageal fistula (TEF) pre- and postoperatively and to find endoscopic correlates leading to clinical airway symptoms. Methods In a cohort of 362 patients with EA-TEF who underwent 595 tracheoscopies at the Children's Hospital of Cologne between January 1983 and December 2002, impaired tracheal lumen, localization of TEF, tracheal pulsations and corresponding clinical symptoms were retrospectively analyzed. Results The incidence of tracheomalacia was higher in patients with EA and TEF (Gross B, C, D) compared to patients with EA alone (Gross A) and average tracheal collapse does not significantly change before and after surgical repair of the esophagus in all types. Patients with cyanosis while eating and obstructive apnea presented with an average tracheal collapse of 89%. Presence of respiratory symptoms like cough, stridor or bronchitis was not associated with a higher grade of tracheal collapse compared to patients without any airway symptoms (average tracheal collapse of 37% in symptomatic patients vs. 33% in non-symptomatic patients). Conclusion Tracheomalacia tends to be present independently of surgical procedure. Tracheomalacia should be measured by tracheoscopy (in % of tracheal collapse). Patients with a tracheal collapse of > 80%, a ventral pulsation and obstructive apnea or cyanosis in combination, are at risk for life threatening situations.

S265 – Tracheostomy in Bronchopulmonary Dysplasia

Objectives To characterize pediatric patients undergoing tracheotomy for bronchopulmonary dysplasia (BPD). To examine the effects of tracheomalacia on tracheostomy outcomes in these patients. Methods The medical records of 95 patients with BPD who underwent tracheotomy in an academic tertiary care children's hospital over 8 years were evaluated for gestational age, birthweight, ethnicity, gender, co-morbid conditions, duration of ventilator support, duration of hospitalization, number of failed extubation attempts before tracheotomy, age at tracheotomy, and time to decannulation. Results The average gestational age was 28.9 weeks and the average postnatal age at tracheotomy was 27.6 weeks after having failed an average of 1.2 extubation attempts. The patients averaged 268.2 days of hospitalization, with 41.6% still requiring ventilator support and 57.1% still having tracheostomy at the end of the study. Of 27 patients with tracheomalacia, 4 (15%) were eventually decannulated vs. 36 of 68 patients without tracheomalacia (53%). The average time to decannulation among patients with tracheomalacia was 27.4 months and without tracheomalacia was 25.7 months. Decreased gestational age correlated with increased time to decannulation (Cox regression analysis, p=0.035). Of patients with genetic anomalies, 22.7% were eventually decannulated vs. 49.3% of patients without genetic anomalies (p = 0.027). Conclusions This study describes the characteristics of patients undergoing tracheotomy for BPD and begins to clarify the relationship between BPD and tracheomalacia. The presence of tracheomalacia in patients with BPD correlates with decreased likelihood of decannulation, but does not significantly affect time to decannulation. As such, tracheomalacia may be an independent risk factor for worse tracheostomy prognosis.

Tracheomalacia: An experimental animal model for a new surgical approach

Tracheomalacia was created by removing the posterior 50% of the circumference of eight cartilage rings (5–6 cm in length) from the intrathoracic trachea in each of 12 piglets while leaving the mucosa intact. In 6 animals an autologous, free tibial periosteal graft was applied over the defect (graft group). The remaining 6 piglets served as the control group. In all animals, a silastic stent was left in the trachea for 2 weeks to prevent immediate tracheal collapse. The presence of tracheomalacia was assessed 6–8 weeks after surgery. At bronchoscopy total tracheal collapse during coughing occurred only in the controls. As the animals went from quiet breathing to coughing, mean intrathoracic pressure increased from 5 to 80 cm H 2O in both groups, and average sagittal tracheal diameter decreased by 10% in the graft group and 71% in the controls. During coughing, mean resistance to airflow across the defect increased by 0.005 ± 0.002 cm H 2O/liter/min in the graft group, by 0.083 ± 0.96 cm H 2O/liter/min in the controls ( P < 0.005), and by 0.027 cm H 2O/liter/min at the same tracheal level in two normal pigs. At sacrifice 12 weeks postoperatively, bone and collagenized fibrous tissue had been produced by all grafts, without evidence of stricture. This study shows that experimentally induced tracheomalacia can be treated successfully by the application of an autologous periosteal tibial graft, which becomes incorporated into the weakened tracheal wall.

Tracheomalacia in association with congenital tracheoesophageal fistula.

Tracheomalacia is an important cause of morbidity and death following correction of congenital tracheoesophageal fistula and is a well defined syndrome which requires recognition and appropriate treatment. The symptoms and signs allow division into mild, moderate, and severe groups. When the clinical features suggest the presence of tracheomalacia, endoscopy should be carried out in order to confirm the diagnosis and document the severity. Mild and moderate cases can be managed conservatively; efficient and regular physiotherapy is the mainstay of treatment. Severe cases warrant consideration for the operation of tracheopexy which may be lifesaving and will certainly reduce the period of hospitalization and will simplify management.