Treatment Of Post-intubation Tracheal Stenosis Research Articles

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.

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.

Surgical treatment of acquired tracheal stenosis in pediatrics

Acquired tracheal stenosis is a very infrequent lesion in the pediatric age group and may be due to diverse causes, being post-intubation stenosis and stenosis secondary to tracheostomy the most common ones. The management of acquired tracheal stenosis remains controversial. Endoscopic treatment provides immediate relief of symptoms but it is associated with a high recurrence rate, and the use of endoluminal prostheses can increase the length of the stricture complicating future surgery. Conversely, good long-term results have been documented with tracheal resection and primary anastomosis. We describe our experience with tracheal resection followed by end-to-end anastomosis for the treatment of post-intubation tracheal stenosis in 8 patients.

Effect of topical Mitomycin C application in the treatment of post-intubation tracheal stenosis.

Effect of topical Mitomycin C application in the treatment of post-intubation tracheal stenosis.

The evaluation and surgical management of post-intubation tracheal strictures at a thoracic surgery referral centre in South Africa.

Background The surgical treatment of tracheal stenosis following endotracheal intubation or tracheostomy is well described in the developed world. Objectives To describe our surgical experience with this pathology, and highlight the nuances of its diagnosis and management in South Africa. Methods We reviewed the clinical records and archived imaging of all patients who underwent tracheal resection and reconstruction for post-intubation tracheal stenosis between 1 July 2003 and 31 July 2014 in the Department of Cardiothoracic Surgery at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Results During the study period, 42 patients underwent tracheal resection. We evaluated the preoperative bronchoscopic characteristics of the tracheal stricture in all patients, and computed tomography (CT) was used as an adjunct in 28 (66%) patients. The stricture lengths determined by CT and intraoperative measurement were strongly correlated (r (27)=0.506, p=0.006), and the stricture lengths determined by bronchoscopy and intraoperative measurement were weakly correlated (r (41)=0.201, p=0.209). A total of 36 patients (85.7%) underwent surgery via a cervical approach and 6 (14.3%) via a right thoracotomy approach. There was no early mortality, and surgery was complicated by vocal cord palsy in 4 cases, restenosis in 2 cases, infection in 1 case and paraparesis in 1 case. Conclusion Tracheal resection for the treatment of post-intubation tracheal stenosis can be undertaken safely with minimal complications in the developing world, with the vast majority of lesions approached via a cervical approach. A preoperative evaluation of the stricture using CT is an accurate technique for planning tracheal resection and reconstruction.

Surgical treatment of postintubation tracheal stenosis: A retrospective 22-patient series from a single center

We aimed to present cases of postintubation tracheal stenosis (PITS), all due to long-term intubation and treated surgically in a university hospital, and to discuss them in light of the literature. In this retrospective study, 22 patients who were treated with tracheal resection and reconstruction due to PITS were included. Demographics, intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. The mean intubation duration was 16.95 days with a median of 15.00 days. Collar incision was applied in 19 cases (86.4%); in two cases (9.1%) a median sternotomy incision was used; and in the remaining case (4.5%), a right thoracotomy incision was made. The mean tracheal stenosis length was 2.14cm (mean excision length, 2.5cm). In 17 cases (77.3%), the anterior walls were supported with vicryl (polyglactin) suture one by one. No postoperative complications were observed in 12 cases (54.5%). No recurrence developed during the long-term follow-up of 15 of the 22 patients (68.2%). Two patients (9.1%) died in the early stages after surgery, and five patients (22.7%) had a stent inserted due to restenosis. Tracheal resection and end-to-end anastomosis are the most efficient techniques in cases without medical contraindications, despite emerging stent or endoscopic procedures. Endoscopic interventions can be suggested as an alternative to surgery in patients for whom surgery cannot be performed or who develop recurrence.

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.

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

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

Surgical treatment of postintubation tracheal stenosis: Iranian experience of effect of previous tracheostomy

BackgroundPostintubation tracheal stenosis remains the most common indication for tracheal surgery. In the event of a rapid and progressive course of the disease after extubation, surgical approaches such as primary resection and anastomosis or various methods of tracheoplasty should be selected. We report our experience with surgical management of moderate to severe postintubation tracheal stenosis. We also compared intraoperative variables in postintubation tracheal stenosis between those with and without previous tracheostomy.MethodsOver a 5-year period from June 2005 to July 2010, 50 patients aged 14–64 years with moderate (50%–70% of the lumen) to severe (>70%) postintubation tracheal stenosis underwent resection and primary anastomosis. Patients were followed up to assess the surgical outcome. To study the effect of previous tracheostomy on treatment, surgical variables were compared between patients with previous tracheostomy (group A, n = 27) and those without previous tracheostomy (group B, n = 23).ResultsResection and primary anastomosis was performed via either cervical incision (45 patients) or right thoracotomy (five patients). In two patients with subglottic stenosis, complete resection of the tracheal lesion and anterior portion of cricoid cartilage was performed, and the remaining trachea was anastomosed to the thyroid cartilage using a Montgomery T-tube. There was only one perioperative death in a patient with a tracheo-innominate fistula. The length of the resected segment, number of resected rings, and subsequent duration of surgery were significantly greater in group A compared with group B (P < 0.05). Six months after surgery, the outcome was satisfactory to excellent in 47 (95.9%) patients.ConclusionThis surgical approach leads to highly successful results in the treatment of moderate to severe postintubation tracheal stenosis. In addition, previous tracheostomy might prolong the duration of surgery and increase the need for postoperative interventions due to an increase in the length and number of resected tracheal segments. Therefore, in the event of emergency tracheostomy in postintubation tracheal stenosis, insertion of the tracheostomy tube close to the stenotic segment is recommended.

Endobronchial argon plasma coagulation for the management of post‐intubation tracheal stenosis

Post-intubation tracheal stenosis is usually caused by pressure necrosis at the cuff. Despite the fact that this phenomenon is well known and both large volume and low pressure cuffs have been developed, this lesion nevertheless continues to occur. Although the best results for tracheal reconstruction are obtained by an experienced surgeon, not all patients are able to undergo this operation for either medical or personal reasons. Argon plasma coagulation (APC) using flexible bronchoscopy has been successfully employed in the treatment of post-intubation tracheal stenosis in two of the surgery-refused and inoperable patients. The patients immediately experienced a relief of symptoms after APC. APC was thus performed 3-4 times every 1-2 weeks for each patient. In addition, there were no complications related to this procedure. The number of published clinical reports describing APC in benign airway stenosis are increasing. APC has also been reported to have several advantages over other interventional endobronchial techniques in the management of tracheo-bronchial stenosis. We report two patients, and to our knowledge this is the first description of APC being used in the treatment of endobronchial dilatation for post-intubation tracheal stenosis.

Early Endoscopic Treatment of Acute Inflammatory Airway Lesions Improves the Outcome of Postintubation Airway Stenosis

The objective of this study was to compare the results of treating acute postintubation stenotic airway lesions with the results of treating mature lesions and to assess whether early intervention improves the outcome. Patients without previous surgery, treated for postintubation airway stenosis, were reviewed. Those with airway lesions presenting within weeks of intubation (n = 11) were treated with intralesional steroids, laser reduction, and balloon dilatation. Patients with mature airway lesions (n = 20) were initially treated with laser, balloon dilatation, and topical mitomycin C. Preoperative patient and lesion characteristics, details of the treatment, and intervention-free intervals were recorded. Data were compared with unpaired Student t test or chi test as appropriate, and intervention-free intervals were compared with log-rank statistics. Cox regression was used to identify independent predictors of intervention-free interval. There were 18 males and 13 females. The average age at presentation was 47 +/- 2.7 years. The two groups were statistically comparable for demographic and lesion characteristics. Patients treated for acute injury required significantly fewer interventions (P < .03), the majority being treated with a single treatment. They had a significantly longer intervention-free interval (P < .02; log-rank analysis) and did not require external laryngotracheal reconstruction (P < .001) compared with patients treated for mature fibrotic scars leading to airway stenosis. Early treatment of acute fibroinflammatory airway lesions has the potential to favorably modify the natural history of postintubation tracheal injury, raising the tantalizing possibility of an early cure. These findings have significant implications for early identification, referral, and treatment of postintubation tracheal stenosis and need to be confirmed with further studies.

Treatment of post-intubation tracheal stenosis with the Nd-YAG laser at the NRITLD

Treatment of post-intubation tracheal stenosis with the Nd-YAG laser at the NRITLD

Sténoses et complications trachéales postintubation

Granuloma, tracheomalacia, tracheo-œsophageal fistula and glottis œdema are well-known post-intubation complications. Post-intubation tracheal stenosis and tracheal ruptures are described in this article. Main points – Clinical signs of tracheal stenosis and tracheal ruptures are not always typical and diagnosis is often made at a late stage. Treatment of post-intubation tracheal stenosis can be difficult because of the poor health status at the time of the diagnosis. Obstructive fibrinous tracheal pseudomembrane is a recently described and potentially fatal complication of endotracheal intubation. Immediate mechanical ablation of the membrane is curative. Prospects – Management of post-intubation tracheal stenosis should be multidisciplinary. Initial bronchoscopic conservative treatment appears to be applicable to almost all patients and allows secondary surgery to be performed in good conditions. Conservative treatment of tracheal ruptures must be considered, when the rupture is well tolerated or in the opposite case when surgery is contraindicated because of poor general conditions.

気管内挿管後の気管狭窄に対するシリコン T 型気管チューブによる 1 治験例

気管内挿管後の気管狭窄に対するシリコン T 型気管チューブによる 1 治験例