Tracheal Stenosis Research Articles

Congenital Tracheal Stenosis: Two Case Reports and Literature Review

Background: Congenital tracheal stenosis is defined as the narrowing of the airway lumen due to the abnormal formation of complete tracheal cartilage rings. It may present with different clinical pictures, depending on the range and extent of stenosis. We present two cases of congenital tracheal stenosis, with a different range of severity and, consequently, different treatment approaches. Case Presentation: We describe the case of a 3-month-old infant with breathing noise that worsened particularly when crying and after nutrition. He presented a congenital funnel-shaped tracheal stenosis with an associated tracheal bronchus, which was treated endoscopically with an endobronchial stent. The second presented case is of a newborn who presented severe respiratory distress and inspiratory stridor in the first hours of life. A congenital cylindrical tracheal stenosis was diagnosed and it was treated surgically through slide tracheoplasty. Discussion: These two cases showed us that congenital tracheal stenosis can present with a very variable clinical picture. Thus, according to clinical presentation, different treatments can be considered. Conclusion: We underline the importance of considering congenital tracheal stenosis in the differential diagnosis of prolonged wheezing and recurrent airway infections.

PD-L1 Acts Independently of PD-1 as a Marker of Pathologic Fibroblasts in Laryngotracheal Stenosis.

Laryngotracheal stenosis (LTS) describes fibrotic airway obstruction that is life-threatening without treatment. Targeted therapies are needed as an adjunct to surgical management. We have previously observed the upregulation of immune checkpoint programmed cell death (PD)-1 and its ligand, PD-L1, in patients with LTS. This study aims to determine whether PD-1 and PD-L1 play a role in the pathophysiology of LTS. Basic science. Laboratory. Fibroblasts derived from the subglottic scar of 5 iSGS patients were cultured ex vivo with transforming growth factor β (TGFβ), PD-L1 agonist (PD-1), and PD-L1 blockade (anti-PD-L1). PD-L1, TGFβ receptor II (TGFβRII), and Collagen-1 expression were quantified by flow cytometry. A validated chemomechanical injury model of subglottic stenosis was applied in PD-1 knockout and wild-type (WT) mice, and subglottic thickening was assessed by histologic analysis. TGFβ significantly increased the expression of PD-L1 and Collagen-1 in human airway scar fibroblasts (P < .05). PD-1 knockout mice demonstrated no significant difference in subglottic airway fibrosis compared to WT mice. Ex vivo PD-L1 modulation had no impact on fibroblast Collagen-1 expression. PD-L1 high-intensity fibroblasts expressed greater Collagen-1 and TGFβRII compared to PD-L1 low-intensity fibroblasts. PD-1 knockout does not protect mice from the development of laryngotracheal fibrosis. However, its ligand, PD-L1 is highly expressed on pathologic fibroblasts unique to scar, characterized by high Collagen-1 and TGFβRII expression. PD-L1 is also upregulated in conjunction with Collagen-1 by TGFβ stimulation. PD-L1 may act independently of PD-1 to sensitize fibroblasts to TGFβ, suggesting direct targeting of PD-L1 may have therapeutic potential in LTS.

Copper hydrogen phosphate nanosheets functionalized hydrogel with tissue adhesive, antibacterial, and angiogenic capabilities for tracheal mucosal regeneration

Timely and effective interventions after tracheal mucosal injury are lack in clinical practices, which elevate the risks of airway infection, tracheal cartilage deterioration, and even asphyxiated death. Herein, we proposed a biomaterial-based strategy for the repair of injured tracheal mucosal based on a copper hydrogen phosphate nanosheets (CuHP NSs) functionalized commercial hydrogel (polyethylene glycol disuccinimidyl succinate-human serum albumin, PH). Such CuHP/PH hydrogel achieved favorable injectability, stable gelation, and excellent adhesiveness within the tracheal lumen. Moreover, CuHP NSs within the CuHP/PH hydrogel effectively stimulate the proliferation and migration of endothelial/epithelial cells, enhancing angiogenesis and demonstrating excellent tissue regenerative potential. Additionally, it exhibited significant inhibitory effects on both bacteria and bacterial biofilms. More importantly, when injected injured site of tracheal mucosa under fiberoptic bronchoscopy guidance, our results demonstrated CuHP/PH hydrogel adhered tightly to the tracheal mucosa. The therapeutic effects of the CuHP/PH hydrogel were further confirmed, which significantly improved survival rates, vascular and mucosal regeneration, reduced occurrences of intraluminal infections, tracheal stenosis, and cartilage damage complications. This research presents an initial proposition outlining a strategy employing biomaterials to mitigate tracheal mucosal injury, offering novel perspectives on the treatment of mucosal injuries and other tracheal diseases.

Utility of Flexible Bronchoscopy as an Interventional Tool in Children: A Single-Center Cross-Sectional Study

AbstractThe aim of this study was to study the utility of pediatric flexible bronchoscopy as an interventional tool. This is a prospective study conducted in a tertiary care hospital. The studied patients underwent flexible bronchoscopy for various diagnostic and therapeutic reasons. The endpoint was to document the type of therapeutic procedure done in a patient, success rate, and any procedural complications encountered. During the 7-year period, a total of 824 different bronchoscopic procedures were conducted. The majority of procedures were for diagnostic reasons. A total of 68 therapeutic procedures were performed successfully, which included foreign body retrieval in 46 patients, bronchoscopic intubation in 5 patients, transbronchial needle aspiration (TBNA) in 4 patients, dilatation of tracheal stenosis in 4 patients, mucus plug removal in 3 patients for lung collapse, postoperative hydatid membrane removal in 3 patients, whole lung lavage in 2 patients, and transbronchial needle biopsy (TBNB) for suspected fibrosing mediastinitis in 1 patient. The 7-year audit of therapeutic role of flexible bronchoscopy (FB) in children revealed that the procedure is safe and can be utilized for many therapeutic procedures in children, including removal of aspirated foreign bodies, bronchoscopic intubation, dilatation of tracheal stenosis, treatment of atelectasis, and collection of biopsy specimens from the mediastinum. The procedure is safe and carried no major complication rate.

Airway management algorithm during circular tracheal resection in adult patients with cicatricial stenosis (a single-center study)

The objective was to present the experience of airway management algorithm in patients with different localization of stenosis during circular tracheal resection.Materials and methods. The retrospective analysis included 84 patients with grade II cicatricial stenosis who underwent circular tracheal resection at the period from 2018 to 2023. The patients were divided into two groups: group 1 with long-segment tracheal stenosis and group 2 with short-segment tracheal stenosis (39 and 45 patients, respectively). The age of patients in group 1 was 43 years [28–55] versus 48 [35–61] years in group 2 (p = 0.19). The patients in the groups were comparable in terms of the main parameters: gender, the ratio of women to men, BMI, class of cardiological risk, degree of risk of respiratory complications and pneumonia, degree of disability. Airway management control during surgery was provided by tracheal intubation with the installation of an endotracheal tube (ETT) proximal to tracheal stenosis or with a supraglottic airway device (laryngeal mask) i-gel (LM) before the main stage, followed by the application of the «apnea-ventilation-apnea» technique at the main stage. In patients with tracheostomy, airway management was performed by inserting endotracheal tube (ETT) into the tracheostomy opening using the «apnea-ventilation-apnea» technique until the completion of the main stage, followed by tracheal intubation through the mouth using a bronchoscope. All patients included in this study underwent tracheoplasty; patients with preserved tracheostomy were not included in the study. The choice of the method of airway management was determined after a joint discussion of the patient with the operating surgeon, endoscopists, as well as after evaluating the predictors of difficult airways and the presence of a tracheostomy in the patient.Results. The incidence of patients with tracheostomy in group 1 – 23 (59%) was higher than in group 2 – 9 (16%) (OR 5.75, 95% CI 2.18–15.17; p &lt; 0.0001), which influenced the choice of tactics for airway management, since LM tracheostomy was not used in this group of patients. The choice of tactics for airway management algorithm also depended on the extent of stenosis, so LM was used more often in group 2 – 28 (62.2%) than in group 1 – 12 (30.8%) (p = 0.004). We associate such differences with the presence of a large number of patients with tracheostomy in group 1. For airway management during surgery, LM was used in 90% of cases with cervical localization of stenosis. In group 1, the time of anesthesia and mechanical ventilation increases compared to group 2: 245 [210–275] versus 215 [180–240] min (p = 0.022) and 265 [220–400] versus 210 [180–320] min (p = 0.015), respectively. The frequency of waking up in the operating room and regaining the ability to breathe independently was higher in patients in group 2: 35 (77.8%) than in group 1 22 (56.4%) (OR 2.7, 95% CI 1.05–6.97; p = 0.036). No difference in length of hospital stay was observed in the extent of stenosis and the chosen airway management algorithm.Conclusion. The choice of airway management algorithm during circular tracheal resection in patients with grade II cicatricial stenosis is depended on the localization and extent of tracheal stenosis. The choice of laryngeal mask i-gel as the airway management algorithm is safe and alternative algorithm with tracheal intubation with short-segment cervical stenosis and absence of tracheostomy.

Airway management for endoscopic treatment of laryngotracheal stenosis

ObjectivesTo describe the airway management techniques used during endoscopic management of laryngotracheal stenosis (LTS), and to identify patient, surgical, and clinician factors that are associated with use of jet ventilation, transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE), and intermittent apnea, including primary technique success vs failure and complications. MethodsRetrospective review of electronic medical records was performed for all patients undergoing direct laryngoscopy for LTS over a seven-year period. Patients with an existing tracheostoma at the time of surgery were excluded. Univariate chi-squared analyses were performed to identify patterns in airway management based on patient and surgical factors. ResultsA total of 92 endoscopic surgeries for 41 unique patients were identified. Airway management techniques differed based on the procedure performed (P < 0.001). Jet ventilation and THRIVE were particularly associated with subglottic procedures, and transtracheal jet ventilation with supraglottic procedures. There were no differences in complication rate based on airway management technique. The rate of primary airway plan failure was 50 % for THRIVE, 15 % for jet ventilation, 2 % for intermittent apnea, and 0 % for endotracheal intubation (p = 0.002). The presence of an anesthesiologist specializing in head and neck anesthesia was associated with significantly greater rates of jet ventilation and THRIVE (41 % vs 7 % for jet ventilation, 9 % vs 4 % for THRIVE; p = 0.002). ConclusionPatient and surgical factors play an important role in airway management planning for patients undergoing endoscopic laryngotracheal procedures. The presence of a head and neck anesthesiologist was associated with a more diverse array of airway management options for these patients.

Comparison of tracheal diameter in non-brachycephalic versus brachycephalic dogs using manubrium and thoracic inlet tracheal indexes.

Narrowed tracheal lumen diameter (TLD) in dogs caused by congenital hypoplasia or acquired tracheal stenosis can result in adverse health effects. Standardized tracheal scores calculated from radiographic measurements have been used to assess tracheal diameter however comparisons have not been made to characterize differences in tracheal lumen among breeds. The main objective of this study was to compare tracheal scores at three regions of the trachea among non-brachycephalic dogs, non-bulldog brachycephalic dogs, and bulldogs. Medical records and thoracic radiographs of clinically normal dogs were reviewed. The TLDs 79 of three different tracheal regions (caudal cervical, thoracic inlet, and intrathoracic) were standardized by the manubrium length (ML) and thoracic inlet distance (Ti-D) to calculate the manubrium and thoracic inlet tracheal indexes (M-TI and Ti-TI) at each region. Statistical analysis was used to analyze the differences in tracheal scores among the three breed populations. Overall, M-TI and Ti-TI varied significantly (p < 0.0001) at the three tracheal levels among the three breed populations. Bulldogs and non-bulldog brachycephalic breeds possessed lower (p < 0.016) M-TI and Ti-TI than non-brachycephalic breeds at the three tracheal regions, and bulldogs possessed the lowest M-TI and Ti-TI scores at all measured regions. Averaged M-TIs <0.38, <0.34, <0.32 in non-brachycephalic, non-bulldog brachycephalic, and bulldog breeds, respectively, may indicate tracheal hypoplasia. Utilizing M-TI can be recommended for the assessment of canine TLD however further investigation in dogs with concurrent respiratory diseases is warranted.

7914 Staged Treatment with Radioiodine Following Lobectomy in a Case of High Risk Papillary Thyroid Carcinoma

Abstract Disclosure: L. Pathak: None. A. Sharma: None. K. Rao: None. M.G. Jakoby: None. Introduction: Radioiodine ([1]3[1]I ) is usually reserved for patients with differentiated thyroid carcinoma (DTC) who are at high risk of persistence or recurrence after thyroidectomy. We present a case of papillary thyroid carcinoma (PTC) with extrathyroidal extension managed by lobectomy and staged [1]3[1]I ablation of the contralateral lobe and metastases due to comorbidities that made oncologic resection prohibitive. Case Description: A 58-year-old male had a 2.2 cm focus of PTC in the left thyroid lobe that extended into extrathyroidal soft tissue, adjacent trachea, and completely compromised the left recurrent laryngeal nerve. Due to left vocal cord paralysis and subglottic tracheal stenosis, left lobectomy was performed but oncologic resection (total thyroidectomy and tracheal resection) was deferred. The patient underwent recombinant human TSH (rhTSH) stimulated treatment with 30 mCi (1.1 GBq) of [1]3[1]I for right thyroid lobe ablation followed 60 d later by 180 mCi (6.7 GBq) of [1]3[1]I to treat metastases. Response to treatment was incomplete, with unstimulated thyroglobulin level falling from 293.9 to 18.9 ng/mL 1 y after [1]3[1]I and CT of the neck notable for a 2.7 cm left thyroid bed mass with invasion of adjacent trachea and a 1.0 cm right paratracheal mass, both of which exhibited hypermetabolism on PET imaging and yielded cytology consistent with poorly differentiated thyroid carcinoma (PDTC). A cluster of left supraclavicular lymph nodes showed both hypermetabolism on PET and radioiodine uptake on rhTSH scan. This patient is being prepared for surgical resection of the left thyroid bed and right paratracheal tumors and left lateral lymph node dissection. Discussion: Radioiodine lobar ablation is an alternative to completion thyroidectomy in patients with an unexpected diagnosis of DTC after lobectomy, with a recent meta-analysis finding a success rate of 69%. No difference in thyroid cancer recurrence rates was found in nearly 500 matched pairs of patients undergoing completion thyroidectomy or radioiodine lobar ablation. Unfortunately, staged lobar ablation followed by high dose [1]3[1]I was not successful in treating this high-risk PTC patient. Cases of coexisting PTC and PDTC are reported, and [1]3[1]I treatment was unsuccessful at treating PDTC that was not apparent on postsurgical histopathology. This case indicates that surgery is preferable to staged [1]3[1]I treatment of patients with aggressive PTC, especially if there are no comorbidities that make total thyroidectomy a high-risk procedure. Presentation: 6/2/2024

The T-Type Calcium Channel CACNA1H is Required for Smooth Muscle Cytoskeletal Organization During Tracheal Tubulogenesis.

Abnormalities of tracheal smooth muscle (SM) formation are associated with several clinical disorders including tracheal stenosis and tracheomalacia. However, the cellular and molecular mechanisms underlying tracheal SM formation remain poorly understood. Here, it is shown that the T-type calcium channel CACNA1H is a novel regulator of tracheal SM formation and contraction. Cacna1h in an ethylnitrosourea forward genetic screen for regulators of respiratory disease using the mouse as a model is identified. Cacna1h mutants exhibit tracheal stenosis, disorganized SM and compromised tracheal contraction. CACNA1H is essential to maintain actin polymerization, which is required for tracheal SM organization and tube formation. This process appears to be partially mediated through activation of the actin regulator RhoA, as pharmacological increase of RhoA activity ameliorates the Cacna1h-mutant trachea phenotypes. Analysis of human tracheal tissues indicates that a decrease in CACNA1H protein levels is associated with congenital tracheostenosis. These results provide insight into the role for the T-type calcium channel in cytoskeletal organization and SM formation during tracheal tube formation and suggest novel targets for congenital tracheostenosis intervention.

Laryngotracheal stenosis: a single-center retrospective analysis of endoscopic treatment strategies and recurrence.

Laryngotracheal stenosis is a process of fibrosis that results in airway obstruction; it may be congenital or acquired. Acquired cases are due to iatrogenic, traumatic, infectious and autoimmune causes. Patients present with a spectrum of breathing difficulties that might be fatal. This article presents a unique retrospective cross-sectional study of patients with laryngotracheal stenosis who had endoscopic dilatation, and some had open surgical procedures to describe the evolution after the therapy, to compare the outcomes of the dilatation in comparison to surgical interventions and associated complications in other studies, to provide knowledge to help in dealing with these patients, and to enable educated, independent patient decision-making. In this observational and descriptive study, we aimed to highlight the clinical features, management, and treatment outcomes among twenty-nine patients with laryngotracheal stenosis who were managed by open and endoscopic surgical intervention over a period of 5 years. Data were collected retrospectively from the patients' medical records from February 2016 until July 2022 at a hospital in Jerusalem, which is a tertiary healthcare facility and the only referral center for similar cases from the West Bank, East Jerusalem, and Gaza, with a population of around 8 million. Tables and graphs are used to highlight the statistical study's findings. Data were analyzed using Microsoft Excel software. Twenty-nine patients were involved in the study, with an average age of 32.2 years; 51.7% of them were males. The patients had one or more chronic conditions, such as hypertension and coronary artery disease. The majority of patients (65.5%) had stenosis as a result of orotracheal intubation, and the most common site was the subglottic (68.9%). According to the Cotton-Myer classification, 44.8% of the patients were classified in grade III, 34.4% were included in grade I, 13.7% in grade II, and 6.8% in grade IV. Six patients (20.68%) received surgery for stenosis, and 23 patients had an endo-laryngeal dilatation. Restenosis happened in (58.6%). Mortality rates are almost negligible. Subglottic stenosis is still a challenging condition to manage. The authors describe a single-center experience approach dealing with these conditions. Long-term follow-up for these cases is mandatory as the recurrence rate is still high.

A novel case of simultaneous tracheal stenting and endobronchial valve (EBV) deployment for tracheal stenosis and persistent air leak guided by an endobronchial collateral ventilation assessment system and digital chest drain in malignant esophageal carcinoma.

Persistent air leak may complicate malignant disease of the thorax, causing significant morbidity and mortality. A 51-year-old male with a 30-pack-year history of smoking was diagnosed with metastatic esophageal carcinoma with invasion into the right upper lobe of the lung. He developed a large right hydropneumothorax complicated by empyema leading to persistent air leak despite the insertion of two chest drains. Computed Tomography imaging with 3-dimensional reconstruction showed severe tracheal compression from the enlarging esophageal tumour as well as bronchopleural fistulas in the right upper lobe. Rigid bronchoscopy with metallic tracheal stenting was performed. This was followed by localization and quantification of air leak with an endobronchial collateral ventilation assessment system and a digital chest drain to guide endobronchial valve placement, in a single operative procedure. This novel combination of interventional bronchoscopy techniques enabled successful transition to an ambulatory chest drain and subsequent hospital discharge.

Outcomes of tracheal resection and anastomosis in patients with tracheal stenosis: a clinical perspective

BackgroundTracheal stenosis results from an altered inflammatory response to mucosal damage, which leads to impairment of breathing and can even be fatal if not treated promptly (Ind J Otolaryngol Head Neck Surg 73(4):447–454, 2020). ENT and head and neck surgeons face difficulties while treating tracheal stenosis. Mechanical stress from extended endotracheal intubation or tracheostomy, combined with hypoxic metabolic disturbances during an underlying event, is the most frequent cause of tracheal stenosis (Al-Azhar Int Med J 3(10):149-57, 2022). The main objective of the study is to assess the outcomes of tracheal resection and anastomosis in patients who presented with tracheal stenosis. This emphasizes the need for proper case selection and timely surgical intervention to relieve the airway obstruction and to ensure the effectiveness of tracheal resection and anastomosis as the less morbid approach by avoiding a midline sternotomy.The study was conducted in a tertiary care center on 25 patients who were admitted in ENT ward from the year 2011 to year 2021. Case records of those patients who underwent tracheal resection and anastomosis were analyzed on a retrospective basis. Detailed history taking and clinical examination with appropriate investigations like flexible bronchoscopy, computed tomography with 3-dimensional reconstruction, video laryngoscopy, direct laryngoscopy, and lung function tests were carried out for all the patients in the study as required. An evaluation of GERD was also done. Appropriate surgical procedure was done with regular post-operative follow-up for 18 months.ResultsIn our study, 92% of patients had satisfactory outcomes following tracheal resection and anastomosis, while some patients experienced minor complications. In 8% of patients, the primary surgery failed, among whom one patient underwent revision surgery and is doing well. The other patient with post-traumatic stenosis with a long stenotic segment underwent Shiann Yann Lee procedure in an outside center which resulted in failure following which T tube insertion was done. The patient showed improvement and was decannulated after a month.In our study of 25 patients with tracheal stenosis, postoperative complications occurred and were managed accordingly. However, there was no significant correlation between these complications and patient age, sex, extent of stenosis, preoperative Cotton-Myer grading, or the type of surgical procedure performed. This lack of correlation may be attributed to the limited sample size.ConclusionTracheal resection and anastomosis are challenging procedures and should be done only in centers with experience. Standard treatment consists of resection of the stenotic segment with end-to-end anastomosis. The geometry of the ends to be anastomosed is matched properly to avoid gaps or weak points and for air-tight seal anastomosis.

Case report on tracheo-bronchial Stenting: A Rare procedure

In the expanding era of interventional medicine, tracheo-bronchial stenting has emerged as an exigent procedure with new ray of hope. The most common indications for stenting are to minimise extrinsic airway compression from mass effect, maintain airway patency due to intrinsic obstruction or treat significant nonmalignant airway narrowing or fistula. It plays an important role as a bridge to additional tumor-specific therapies, especially in chemoradiotherapy-naïve patients. Our patient, a 66-year-old lady with history of recurrent oesphageal carcinoma treated with chemotherapy, was suffering from increasing breathlessness with presence of stridor. Tracheo-bronchial stenting (Y-stenting) was done successfully in this patient to relieve her tracheal stenosis as observed in bronchoscopy. We report this case as it highlights the first ever Y-stenting in Bangladesh, might cultivate more feasibilty towards such intervention in different centres. Bangladesh J Medicine 2024; 35: 218-220

Virtues of routine suprahyoid release during tracheal resection and anastomosis in patients with post intubation stenosis.

Postintubation tracheal stenosis is the most common cause of benign tracheal stenosis. Surgical treatment is more challenging in long-segment stenosis. Suprahyoid release can increase tracheal length resected without anastomotic tension in patients with post-intubation tracheal stenosis. Its effect on swallowing has not been objectively studied and this article aims to explore its virtues and potential complications in a tertiary center for airway surgery. A prospective cohort study was conducted on forty consecutive patients from June 2020 till December 2023. Patients of both genders had tracheal resection anastomosis surgery with routine suprahyoid muscle release for resected tracheal segment of more than 2.5 cm in length aiming to decrease the anastomotic tension. Within two weeks postoperatively, a video naso-laryngoscope was done on all the patients to detect any vocal cord disorders, then they were examined by video fluoroscopy swallowing study VFSS to detect swallowing problems. Follow up was done for 6 months postoperatively. 40 patients were studied. Twenty-five patients (62.5%) were males. 21 patients (52.5%) had a cricotracheal resection. VFSS was performed on 38 patients (two patients excluded for serious morbidity). Six (15.7%) and four (10.5%) patients had residual semisolid and solid food in the vallecula and pyriform fossa respectively during swallowing. Five patients (13%) out of eight patients with abnormal VFSS had aspiration and dysphagia. Video nasolaryngoscopy was done pre- and post-operatively and showed that 7 patients (17.5%) had unilateral vocal cord paralysis, two of them had the same lesion preoperatively. Two patients developed postoperative anastomotic complications. All symptoms of dysphagia improved within 3 weeks of the procedure and improvement persisted for 6 months. Suprahyoid muscle release had a considerable reversible drawback on the process of swallowing. Its routine use in high-risk patients requiring long segment tracheal resections could be considered.

Cases of tracheal stenosis diagnosed in the bronchoscopy service of INERAM. Period 2021 – 2023

Cases of tracheal stenosis diagnosed in the bronchoscopy service of INERAM. Period 2021 – 2023

Ultrasound-Guided Percutaneous Tracheostomy in Cardiovascular and Thoracic Surgery of South Korea: Retrospective Evaluation of Efficacy and Safety in Critically Ill Patients.

In intensive care settings, the maintenance of ventilation is typically essential. Tracheostomy is frequently performed to facilitate long-term ventilation and to minimize associated complications. This procedure can be conducted using several techniques, including traditional surgery, endoscopic approaches, and ultrasound-guided methods. We retrospectively examined data from all patients admitted to the intensive care unit of our institution who underwent ultrasound-guided percutaneous tracheostomy (UPCT) between March 2018 and April 2023. The study included a total of 81 patients aged 15 years or older. To assess the incidence of complications, we classified these issues as either minor or major, with major complications encompassing events such as bleeding necessitating blood transfusion. The most frequent minor complication was bleeding that did not require blood transfusion, which occurred in 15 patients (18.5%). Major complications were identified in 7 patients (8.6%), all of whom experienced bleeding that necessitated transfusion. However, we noted no cases of infection, conversion to open surgery, or tracheal stenosis surgery. The complication rate did not significantly differ from those reported in previous studies. These results indicate that UPCT can be safely used in critically ill patients, although further research on this topic is needed.

Stenting of the trachea with cicatricial stenosis, immediate and long-term results

The aim of study Evaluation of the results of stenting in the treatment of cicatricial stenosis of the trachea. Materials and methods During the period from 1995 to 2023, 154 patients with cicatricial stenosis of the trachea were treated (men - 109 (70.77%), women - 45 (29.22%). The age of the patients ranged from 15 to 83 years. Patients of working age (from 20 to 50 years old) were 102 (66, 23%). The causes of stenosis were: tracheostomy and / or prolonged mechanical lung ventilation through a tracheostomy tube (106-68.83%), mechanical ventilation through the orotracheal tube (38-24.67%), in 6 (3.89%) after circular resection of the trachea, in 3 (1.94%) recurrence of stenosis after tracheolaryngoplasty, in 1 (0.64%) after radiation therapy for primary tracheal cancer in the area of tumor stenosis. Results. In 69 (44.80%) patients, tracheal stenting was performed. Indications for stenting: the impossibility of performing circular resection of the trachea due to the severity of the condition (64-92.75%), preoperative preparation (2-2.89%), cicatricial narrowing of the tracheal anastomosis after circular resection of the trachea (2-2.89%), stenosis of the trachea after long-term treatment of staged treatment (tracheolaryngoplasty with the introduction of a T-shaped tube) (1-1.44%). In 67 patients silicone stents of the Dumont type were inserted, in 2 - stents made of an endotracheal tube and fixed to the neck tissues with a non-absorbable ligature. Complications in the postoperative period occurred in 22 (31,88%) patients. There were no lethal outcomes. It was possible to form a lumen sufficient for breathing in 46 (66.66%) patients. Conclusions. Tracheal stenting in patients with cicatricial tracheal stenosis is a safe and highly effective method that can be used both independently and for preoperative preparation. Restenosis that occurs after the stent removing can be corrected by stent reinsertion by circular resection of the trachea performing, if the patient’s condition allows it.

Airway management for patients with tracheal stenosis and severe scar contracture of the face and neck via bronchoscopy: a case report

Both anaesthesiologists and surgeons experience challenges in managing airway stenosis and scar contracture in the face and neck. Herein, we report the case of a 38-year-old woman (BMI 23.1 kg/m2, third-degree burns covering 40% of her body, an American Society of Anaesthesiologists physical status III) with an unusual case of airway constriction. This patient had a predictable difficult airway (mouth opening of 2 cm, bilateral nostril scar hyperplasia, Mallampatti score III, scarring of the head and neck, and severe tracheal stenosis). Tracheal stenosis measuring 5.5 mm in width as observed 8 cm below the glottis, and the bronchoscope could not pass through it. After two failed attempts at laryngeal mask insertion, we decided to instead insert a custom-made tracheal tube under the guidance of a fiberoptic bronchoscope. The operation was successful, and the patient was transferred to the intensive care unit (ICU).

Tracheal resection and anastomosis in postintubation tracheal stenosis: a systematic review.

Surgical resection of the stenotic segment with end-to-end anastomosis is considered the gold standard in postintubation tracheal stenosis. However, outcomes of this concrete aetiology are not well described. With the aim to examine the extent, range and characteristics of the existing evidence, a scoping review was performed. Data sources included MEDLINE, Scopus, Ovid and the Cochrane databases. Inclusion criteria consisted of studies in adult patients with postintubation tracheal stenosis that reported characteristics, surgical management and outcomes. A total of 125 articles were identified, of which 10 were included in the final analysis. All studies were case reports or case series (level 4 evidence) grouping 110 patients, 75 males and 35 females. The age ranged from 15 to 71 years. Cotton-Myer stenosis grade was 1 [1 (0.9%)], 2 [25 (22.7%)], 3 [70 (63.6%)] and 4 [14 (12.7%)]. Stenosis location was in the tracheal upper-third in 108 (98.2%), in the middle-third in 1 (0.9%) and in the lower-third in 1 (0.9%). Stenosis length ranged from 1 to 5.6 cm. Follow-up ranged from 1 to 60 months (2 years for the most). Most frequent complications were transitory dysphagia in 13 (11.3%), granuloma formation in 8 (7.3%), dehiscence or air leak in 5 (4.5%) and wound infection in 4 (3.6%). Restenosis rate ranged from 2% to 25%. There was no perioperative mortality. Tracheal resection and primary anastomosis in postintubation tracheal stenosis appear to be safe and effective in the short and mid-terms; however, the very low level of evidence found prevents definitive conclusions.

Characteristics of lung resistance and elastance associated with tracheal stenosis and intrapulmonary airway narrowing in ex vivo sheep lungs

BackgroundUnderstanding the characteristics of pulmonary resistance and elastance in relation to the location of airway narrowing, e.g., tracheal stenosis vs. intrapulmonary airway obstruction, will help us understand lung function characteristics and mechanisms related to different airway diseases.MethodsIn this study, we used ex vivo sheep lungs as a model to measure lung resistance and elastance across a range of transpulmonary pressures (5–30 cmH2O) and ventilation frequencies (0.125–2 Hz). We established two tracheal stenosis models by inserting plastic tubes into the tracheas, representing mild (71.8% lumen area reduction) and severe (92.1%) obstructions. For intrapulmonary airway obstruction, we induced airway narrowing by challenging the lung with acetylcholine (ACh).ResultsWe found a pattern change in the lung resistance and apparent lung elastance as functions of ventilation frequency that depended on the transpulmonary pressure (or lung volume). At a transpulmonary pressure of 10 cmH2O, lung resistance increased with ventilation frequency in severe tracheal stenosis, whereas in ACh-induced airway narrowing the opposite occurred. Furthermore, apparent lung elastance at 10 cmH2O decreased with increasing ventilation frequency in severe tracheal stenosis whereas in ACh-induced airway narrowing the opposite occurred. Flow-volume analysis revealed that the flow amplitude was much sensitive to ventilation frequency in tracheal stenosis than it was in ACh induced airway constriction.ConclusionsResults from this study suggest that lung resistance and apparent elastance measured at 10 cmH2O over the frequency range of 0.125-2 Hz can differentiate tracheal stenosis vs. intrapulmonary airway narrowing in ex vivo sheep lungs.