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      Use of dedicated optical tracheal dilator for postintubation tracheal stenosis: First report from India

      case-report

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          Abstract

          Postintubation tracheal stenosis is preventable yet commonly occurring clinical condition. Early in the disease, nonspecific symptoms may predominate but once the stenosis reaches a critical stage life-threatening respiratory compromise may ensue. Bronchoscopic interventions are an invaluable tool in the management both as a primary treatment and as an interim procedure before the surgery. Optical dilatational tracheoscopy is a safe and minimally invasive procedure in the treatment of benign tracheal stenosis. Involvement of multidisciplinary team early in the treatment planning gives the best possible results.

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          Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients.

          J Stauffer, Eric Olson, Rafe Petty (1980)
          A prospective study of the complications and consequences of translaryngeal endotracheal intubation and tracheotomy was conducted on 150 critically ill adult patients. Adverse consequences occurred in 62 percent of all endotracheal intubations and in 66 percent of all tracheotomies during placement and use of the artificial airways. The most frequent problems during endotracheal intubation were excessive cuff pressure requirements (19 percent), self-extubation (13 percent) and inability to seal the airway (11 percent). Patient discomfort and difficulty in suctioning tracheobronchial secretions were very uncommon. Problems with tracheotomy included stomal infection (36 percent), stomal hemorrhage (36 percent), excessive cuff pressure requirements (23 percent) and subcutaneous emphysema or pneumomediastinum (13 percent). Complications of tracheotomy were judged to be more severe than those of endotracheal intubation. Follow-up studies of survivors revealed a high prevalence of tracheal stenosis after tracheotomy (65 percent) and significantly less after endotracheal intubation (19 percent)(p < 0.01). Thirty-nine of 41 (95 percent) patients with endotracheal intubation and 20 of 22 (91 percent) patients with tracheotomy had laryngotracheal injury at autopsy. Ulcers on the posterior aspect of the true vocal cords were found at autopsy in 51 percent of the patients who died after endotracheal intubation. There was no significant relationship between the duration of endotracheal intubation or tracheotomy and the over-all amount of laryngotracheal injury at autopsy, although patients with prolonged endotracheal intubation followed by tracheotomy had more laryngeal injury at autopsy (P = 0.06) and more frequent tracheal stenosis (P = 0.05) than patients with short-term endotracheal intubation followed by tracheotomy. Adverse effects of both endotracheal intubation and tracheotomy are common. The value of tracheotomy when an artificial airway is required for periods as long as three weeks is not supported by data obtained in this study.
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            Postintubation tracheal stenosis. Treatment and results.

            D. Wright, H Grillo, J C Wain … (1995)
            A total of 503 patients underwent 521 tracheal resections and reconstructions for postintubation stenosis from 1965 through 1992. Fifty-three had had prior attempts at surgical resection, 51 others had undergone various forms of tracheal or laryngeal repair, and 45 had had laser treatment. There were 251 cuff lesions, 178 stomal lesions, 38 at both levels, and 36 of indeterminate origin. Sixty-two patients with major laryngeal injuries required complete resection of anterior cricoid cartilage and anastomosis of trachea to thyroid cartilage, and 117 had tracheal anastomosis to the cricoid. A cervical approach was used in 350, cervicomediastinal in 145, and transthoracic in 8. Length of resection was 1.0 to 7.5 cm. Forty-nine had laryngeal release to reduce anastomotic tension. A total of 471 patients (93.7%) had good (87.5%) or satisfactory (6.2%) results. Eighteen of 37 whose operation failed underwent a second reconstruction. Eighteen required postoperative tracheostomy or T-tube insertion for extensive or multilevel disease. Twelve died (2.4%). The most common complication, suture line granulations (9.7%), has almost vanished with the use of absorbable sutures. Wound infection occurred in 15 (3%) and glottic dysfunction in 11 (2.2%). Five had postoperative innominate artery hemorrhage. Resection and reconstruction offer optimal treatment for postintubation tracheal stenosis.
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              Laryngotracheal injury due to endotracheal intubation: incidence, evolution, and predisposing factors. A prospective long-term study.

              R Estopa, A Agusti, A. Marin … (1983)
              The purpose of this study was to assess the incidence, evolution and long-term effects of laryngotracheal lesions due to endotracheal intubation and to evaluate the import of factors in the genesis of laryngotracheal injury. Over a 12-month period, we performed fiberoptic bronchoscopy (FBS) in 19 critically ill patients with endotracheal intubation. Early laryngeal lesions, mainly true vocal cord granulomas and ulceration, appeared in 12 (63%) patients and were resolved by the 3rd month in all but 3 patients. In 6 (31%) patients, early tracheal lesions appeared in the form of ring-shaped tracheitis at the cuff level and granulomas at the tube-tip level; in 2 (10%) patients, an established tracheal stenosis developed and early detected ring-shaped tracheitis preceded circumferential fibrous stenosis. Severe respiratory failure, high cuff pressure, and secretion infection showed a statistical correlation to tracheal injury.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Lung India
                Journal ID (iso-abbrev): Lung India
                Journal ID (publisher-id): LI
                Title: Lung India : Official Organ of Indian Chest Society
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0970-2113
                ISSN (Electronic): 0974-598X
                Publication date (Print): Sep-Oct 2018
                Volume: 35
                Issue: 5
                Pages: 417-420
                Affiliations
                [1] Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
                [1 ] Department of Anesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
                [2 ] Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
                Author notes
                Address for correspondence: Dr. Ajmal Khan, Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India. E-mail: drajmal13@ 123456gmail.com
                Article
                Publisher ID: LI-35-417
                DOI: 10.4103/lungindia.lungindia_372_17
                PMC ID: 6120308
                PubMed ID: 30168462
                SO-VID: 5e7d1572-90db-4f04-acfb-b047c6b59d7f
                Copyright © Copyright: © 2018 Indian Chest Society
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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                Categories
                Subject: Case Report

                ScienceOpen disciplines: Respiratory medicine
                Keywords: central airway obstruction,interventional pulmonology,optical dilatational tracheoscopy,surgical resection,tracheal stenosis
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: central airway obstruction, interventional pulmonology, optical dilatational tracheoscopy, surgical resection, tracheal stenosis

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