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Yang M, Li H, Zhou Y, Wei H, Cheng Q. Type and morphology affect the success rate of bronchoscopy for postintubation tracheal stenosis. Laryngoscope Investig Otolaryngol 2024; 9:e70002. [PMID: 39171096 PMCID: PMC11337920 DOI: 10.1002/lio2.70002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/14/2024] [Accepted: 08/07/2024] [Indexed: 08/23/2024] Open
Abstract
Objective With advancements in respiratory interventional techniques, bronchoscopic intervention technology has emerged as a viable approach for managing postintubation tracheal stenosis (PITS). However, there was a paucity of research investigating the potential impact of stenosis characteristics and morphology (such as stenosis degree, length, type, and morphology) on bronchoscopic intervention treatment prognosis for PITS patients. This study was to assess the impact of various preoperative stenosis characteristic factors on the bronchoscopic cure rate among patients. Methods This is a retrospective study analyzing the medical records of patients with PITS who received bronchoscopic intervention at the tertiary interventional pulmonology center. Results Among the cases, 115 individuals achieved a in a success rate of 79.86% for bronchoscopic intervention therapy and were assigned to Group S. On the other hand, 29 cases required surgical intervention, accounting for a surgical treatment rate of 20.14% and were assigned to Group F. The stenosis in the Group F predominantly exhibited irregular shapes with scar granulation accompanied by tracheal chondromalacia collapse. Patients in group S experienced fewer total procedures, rigid bronchoscopy treatment, intraoperative hypoxemia, needed emergency re-bronchoscopy in 24 h and transferred to ICU postoperatively. Patients with pure scar and granuloma, the rate of bronchoscopic success cure was higher than patients with scar granulation accompanied by tracheal chondromalacia (odds ratio: 8.208; 95% confidence interval: 2.755-24.459), and regular stenosis morphology was associated with a higher bronchoscopic success cure rate (odds ratio: 9.463; 95% confidence interval: 3.128-28.623). Conclusion Irregular airway stenosis, chondromalacia or airway collapse are key factors affecting the success rate of bronchoscopic treatment for post-intubation tracheal stenosis. Level of evidence: 4 (historically controlled studies).
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Affiliation(s)
- Mingyuan Yang
- Center of Anesthesiology and PainEmergency General HospitalBeijingChina
| | - Hong Li
- Center of Anesthesiology and PainEmergency General HospitalBeijingChina
| | - Yunzhi Zhou
- Department of Pulmonary and Critical Care MedicineEmergency General HospitalBeijingChina
| | - Huafeng Wei
- Department of Anesthesiology and Critical CareUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Qinghao Cheng
- Center of Anesthesiology and PainEmergency General HospitalBeijingChina
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Yang M, Li H, Zhou Y, Li H, Wei H, Cheng Q. Airway collapse hinders recovery in bronchoscopy therapy for postintubation tracheal stenosis patients. Eur Arch Otorhinolaryngol 2024; 281:3061-3069. [PMID: 38582815 PMCID: PMC11065913 DOI: 10.1007/s00405-024-08602-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/05/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Expiratory central airway collapse (ECAC) following postintubation airway stenosis (PITS) is a rare phenomenon. The impact of airway malacia and collapse on the prognosis and the success rate of bronchoscopic interventional therapy in patients with PITS had been inadequately investigated. OBJECTIVE The aim of this research was to assess the influence of airway malacia and collapse on the efficacy of bronchoscopic interventional therapy in patients with PITS. DESIGN This retrospective analysis examined the medical documentation of individuals diagnosed with PITS who underwent bronchoscopic intervention at the tertiary interventional pulmonology center of Emergency General Hospital from 2014 to 2021. MAIN OUTCOME MEASURES Data pertaining to preoperative, perioperative, and postoperative stages were documented and subjected to analysis. RESULTS The patients in malacia and collapse group (MC group) exhibited a higher frequency of perioperative complications, including intraoperative hypoxemia, need for reoperation within 24 h, and postoperative intensive care unit admission rate (P < 0.05, respectively). Meanwhile, patients in group MC demonstrated significantly worse postoperative scores (higher mMRC score and lower KPS score) compared to those in pure stenosis group (P < 0.05, respectively), along with higher degrees of stenosis after treatment and a lower success rate of bronchoscopic intervention therapy cured (P < 0.05, respectively). Pearson analysis results showed that these terms were all significantly correlated with the occurrence of airway malacia and collapse in the airway (P < 0.05, respectively). CONCLUSION The presence of malacia or collapse in patients with PITS was associated with increased perioperative complications following bronchoscopic interventional therapy, and significantly reduced the long-term cure rate compared to patients with pure tracheal stenosis. Trial registration Chinese Clinical Trial Registry on 06/12/2021. REGISTRATION NUMBER ChiCTR2100053991.
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Affiliation(s)
- Mingyuan Yang
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China
| | - Hong Li
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China
| | - Yunzhi Zhou
- Department of Pulmonary and Critical Care Medicine, Emergency General Hospital, Beijing, China
| | - Hao Li
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China
| | - Huafeng Wei
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Qinghao Cheng
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China.
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Schramm D, Freitag N, Kötz K, Iglesias-Serrano I, Culebras-Amigo M, Koblizek V, Pérez-Tarazona S, Cases Viedma E, Srikanta JT, Durdik P, Darwiche K, Rubak S, Stafler P. Cryotherapy in the paediatric airway: Indications, success and safety. Respirology 2022; 27:966-974. [PMID: 36054726 DOI: 10.1111/resp.14353] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/15/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Cryotherapy in interventional bronchoscopy is a new treatment modality, which has recently been made available for the paediatric airway. Lack of experience and safety concerns have led to hesitant adaptation. The aim of this study was to assess indications, success rates and complications of airway cryotherapy in children. METHODS Bronchoscopists from medical centre performing cryotherapy in patients between 0 and 18 years were invited to participate in a prospective study based on an online questionnaire. Patient and participant data were collected between June 2020 and June 2021. RESULTS A total of 69 cryotherapy procedures were performed in 57 patients a for three main indications: Biopsy (30), restoration of airway patency (23) and foreign body aspiration (16). The overall success rate was 93%, the remaining 7% were performed for foreign body removal and required a switch of technique. Restoration of airway patency was successfully applied in various pathologies, including mucus plugs, bronchial casts and post traumatic stenosis. The diagnostic yield of transbronchial biopsies was 96%. No severe complications were encountered; one pneumothorax following a cryobiopsy required a chest drain for 48 h. No child was admitted to intensive care or died from a procedural complication. CONCLUSION In this largest paediatric case collection to date, cryotherapy was safe and carried a high success rate. Cryobiopsy compares favourably to the widely used forceps biopsy and could replace it in the future. Paediatric bronchoscopists are encouraged to add cryotherapy to their armamentarium of airway interventions.
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Affiliation(s)
- Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Karsten Kötz
- Queen Silvias Children Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ignacio Iglesias-Serrano
- Unitat de Pneumologia Pediàtrica i Fibrosi Quística, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Vladimir Koblizek
- Department of Pneumology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czechia
| | | | - Enrique Cases Viedma
- Respiratory Endoscopy Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - J T Srikanta
- Pediatric Interventional Pulmonology, Allergy and Sleep Medicine, Aster CMI and RV Hospitals, Bengaluru, India
| | - Peter Durdik
- Pediatric Department, University Hospital Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Kaid Darwiche
- Department for Interventional Pneumology, Ruhrlandklinik-West German Lung Center, University Medicine Essen, Essen, Germany
| | - Sune Rubak
- Department of Pediatrics and Adolescents Medicine, Danish Center of Pediatric Pulmonology and Allergology, University Hospital of Aarhus, Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Patrick Stafler
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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张 光, 王 崇, 彭 帅, 谷 瑞, 谢 晓, 罗 健, 罗 征. [The Effect of Interventional Treatment with Bronchoscopy in 10 Children with Acquired Subglottic Stenosis]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2022; 53:166-170. [PMID: 35048619 PMCID: PMC10408871 DOI: 10.12182/20220160109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the effects of interventional therapy with bronchoscopy in children with acquired subglottic stenosis (SGS). METHODS The clinical data of ten pediatric inpatients with acquired SGS who were admitted to Children's Hospital of Chongqing Medical University, as well as their follow-up information obtained 1 week, 1 month, 3 months and 6 months after the procedure was done.were retrospectively analyzed to examine the effect of interventional bronchoscopic therapies, including balloon dilatation, holmium laser, and cryotherapy, in pediatric patients with acquired SGS. RESULTS Among the 10 patients with acquired SGS, there were 5 boys and 5 girls aged between 1 month and 6 years and 5 months, with a median age of 11 months and 1 day. Among the 5 patients with acute acquired SGS, two were treated with balloon dilatation only, with one cured and one showing clinical improvement, while three received comprehensive interventional therapy combining balloon dilatation, holmium laser, and cryotherapy, with two cured and one showing improvement. Among the 5 patients with chronic acquired SGS, four cases were cured with comprehensive interventional therapy, while one case suffered from aggravated upper airway obstruction 4 + hours after balloon dilatation. The patient was subsequently put on invasive mechanical ventilation for 4 days, but was unable to be extubated. The parents signed do-not-resuscitate order and the patient died afterwards. Bronchoscopy performed 1 week, 1 month and 3 months after the procedure was done showed that the SGS was improved to varying degrees. CONCLUSION Bronchoscopy intervention is an effective therapy for acquired SGS in children.
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Affiliation(s)
- 光莉 张
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 崇杰 王
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 帅 彭
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 瑞雪 谷
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 晓虹 谢
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 健 罗
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - 征秀 罗
- 重庆医科大学附属儿童医院 呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病教育部重点实验室 儿科学重庆市重点实验室 (重庆 400014)Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of the Ministry of Education, and Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
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Tebbe W, Wittkowski H, Tebbe J, Hülskamp G. Case report: Idiopathic subglottic stenosis in a girl; successful treatment with macrolides. Front Pediatr 2022; 10:888282. [PMID: 36061399 PMCID: PMC9434006 DOI: 10.3389/fped.2022.888282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
An 8-year-old girl presented with treatment-refractory cough and inspiratory stridor. Bronchoscopies showed progressive scarring leading to narrowing of the proximal trachea (Myer-Cotton Grade 2) and epithelial metaplasia of the tracheal and bronchial mucosa. After excluding other causes of congenital and acquired tracheal stenosis, an idiopathic subglottic tracheal stenosis (iSGS) was diagnosed. Because of the patient's young age, a judicious therapeutic approach seemed appropriate. Therapy with azithromycin, followed by roxithromycin, was started. Symptoms almost completely subsided, spirometry normalized, and endoscopic and histologic findings improved considerably. Therapy has been continued for more than 3 years with normal lung function values, and no compromise on physical activities and development. In instances of iSGS, therapy with macrolides is worth considering before more invasive procedures such as dilatation, laser, intralesional injections, or surgical resection are performed.
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Affiliation(s)
- Wolfgang Tebbe
- Pädiatrische Pneumologie, Klinik für Kinder - und Jugendmedizin, Clemenshospital, Münster, Germany
| | - Helmut Wittkowski
- Pädiatrische Rheumatologie und ImmunologieKlinik für Kinder - und Jugendmedizin, Universitätsklinikum Münster (UKM), Münster, Germany
| | - Johannes Tebbe
- Allgemeine Pädiatrie, Pädiatrische Pneumologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Münster (UKM), Münster, Germany
| | - Georg Hülskamp
- Pädiatrische Pneumologie, Klinik für Kinder - und Jugendmedizin, Clemenshospital, Münster, Germany
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Okumuş M, Yıldırım Ö, Kilercik H, Baş S. Tetralogy of Fallot and subglottic stenosis surgery with holmium laser in the same session. Gen Thorac Cardiovasc Surg 2021; 70:295-297. [PMID: 34846683 DOI: 10.1007/s11748-021-01753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
The incidence of subglottic stenosis after pediatric cardiac surgery is around 0.57-2.3%. An 11-year-old female patient, who underwent modified Blalock-Taussig shunt surgery at the age of 4 months, was interned for total repair of tetralogy of Fallot. Subglottic stenosis was revealed in preoperative examination with indirect laryngoscopy. Total repair of tetralogy of Fallot was performed under cardiopulmonary bypass support. While the patient was still on cardiopulmonary bypass support, subglottic stenosis was treated by holmium laser successfully without a complication. In suitable patients, cardiac and endoscopic laryngeal operations can be successfully and safely performed under cardiopulmonary bypass with a holmium laser.
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Affiliation(s)
- Mustafa Okumuş
- Faculty of Medicine, Department of Pediatric Surgery, Gaziosmanpaşa Hospital and Bahat Hospital, Yeni Yüzyıl University, Merkez Mahallesi, Çukurçeşme caddesi, No: 51, Gaziosmanpaşa, 34245, Istanbul, Turkey.
| | - Özgür Yıldırım
- Faculty of Medicine, Division of Pediatric Cardiovascular Surgery, Department of Cardiovascular Surgery, Yeni Yüzyıl University, İstanbul, Turkey
| | - Hakan Kilercik
- Faculty of Medicine, Department of Anesthesiology, Yeni Yüzyıl University, İstanbul, Turkey
| | - Serap Baş
- Faculty of Medicine, Department of Radiology, Yeni Yüzyıl University, İstanbul, Turkey
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Botsali A, Beksac B, Gahramanov İ, Caliskan E. Erbium:YAG laser augments the penetration of cryotherapy. Lasers Med Sci 2021; 37:353-358. [PMID: 33528669 DOI: 10.1007/s10103-021-03259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/24/2021] [Indexed: 11/29/2022]
Abstract
Cryotherapy is commonly used during dermatologic practice. Several modifications such as an "add-on" to topicals or intralesional applications have been already defined to enhance efficacy. The aim of this study is to test our hypothesis that ablative laser application before cryotherapy would increase the depth of freezing.Throughout this experiment, target points received either cryotherapy alone or a combination of erbium:yttrium-aluminum garnet (erbium:YAG) laser and cryotherapy. Freezing durations of 10 (C10), 20 (C20), and 30 seconds (C30) were investigated. Erbium:YAG laser groups received equal high energy shots with different pulse durations (100 μs versus 1500 μs) before freezing. The treatment points were arranged on the peripheral side of porcine skin specimens, and dermoscopic images revealing the iceball visible from the lateral side were immediately captured. Repeated experimental results were compared by Wilcoxon's test. The comparison of the vertical length of the iceball between the three different freezing durations of 10 seconds, 20 seconds, and 30 seconds was statistically significant (p<0.05). The vertical length of the iceball was higher in both laser groups receiving 30-second freezing (mean ± SD: 4.32±0.53, 3.9±0.38 for micro-short pulse (MSP) and extra-long pulse (XLP), respectively) when compared with 30-second freezing alone (mean ± SD:3.51±0.44) (p=0.016). The two laser settings did not reveal a difference for the penetration of 30-second freezing (p=0.122). In this study, through visual monitorization of the iceball, erbium:YAG laser is found to augment the penetration of cryotherapy. The defined combination regimen has the potential to ameliorate treatment outcomes of cryotherapy.
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Affiliation(s)
- Aysenur Botsali
- Department of Dermatology, Health Sciences University, Gülhane Training and Research Hospital, General Dr. Tevfik Saglam Cad., SBU Gülhane EAH Dermatoloji ABD Etlik, Ankara, Turkey.
| | - Burcu Beksac
- Department of Dermatology, Health Sciences University, Gülhane Training and Research Hospital, General Dr. Tevfik Saglam Cad., SBU Gülhane EAH Dermatoloji ABD Etlik, Ankara, Turkey
| | - İrfan Gahramanov
- Department of Dermatology, Health Sciences University, Gülhane Training and Research Hospital, General Dr. Tevfik Saglam Cad., SBU Gülhane EAH Dermatoloji ABD Etlik, Ankara, Turkey
| | - Ercan Caliskan
- Department of Dermatology, Health Sciences University, Gülhane Training and Research Hospital, General Dr. Tevfik Saglam Cad., SBU Gülhane EAH Dermatoloji ABD Etlik, Ankara, Turkey
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Erratum. Pediatr Investig 2020; 4:64. [PMID: 32852486 PMCID: PMC7331371 DOI: 10.1002/ped4.12173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
[This corrects the article DOI: 10.1002/ped4.12053.].
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Lawlor CM, Shah RK. A novel and promising addition to the treatment arsenal for post-intubation subglottic stenosis: Holmium laser ablation and cryotherapy via flexible bronchoscopy. Pediatr Investig 2019; 3:17-18. [PMID: 32851283 PMCID: PMC7331376 DOI: 10.1002/ped4.12114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Claire M. Lawlor
- Children's National Health SystemDepartment of OtolaryngologyWashingtonDCUSA
| | - Rahul K. Shah
- Children's National Health SystemDepartment of OtolaryngologyWashingtonDCUSA
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