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Sun K, Zhang H, Wang G. Bronchoscopic retrograde recanalization of complete tracheal obliteration after tracheostomy. Auris Nasus Larynx 2021; 49:1046-1050. [PMID: 34001393 DOI: 10.1016/j.anl.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/14/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
Complete tracheal obliteration after tracheostomy remains a considerable challenge for otolaryngologists and pulmonologists. Here, we report for the first time a novel method of interventional bronchoscopy to successfully recanalize complete tracheal obliteration. Three patients with suprastomal tracheal obliteration and tracheostomy dependence were referred to our center for further management. Using interventional bronchoscopy, a TBNA needle was retrogradely inserted from the stoma to locate the original passage through the occlusion, and then its stylet was left as a guide wire for the sequential dilations. Once the tracheal lumen was restored, endoprosthesis would be implanted to maintain the airway patency. All cases achieved successful recanalization with effortless breathing after the treatment and restored phonation. Bronchoscopic retrograde recanalization using a TBNA needle is a promising and effective treatment for complete tracheal obliteration.
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Affiliation(s)
- Kunyan Sun
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Beijing 100034, China
| | - Hong Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Beijing 100034, China
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Beijing 100034, China.
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Kim JH, Ahn JJ, Jegal Y, Bae S, Park SE, Jung MS, Park JI, Cha HJ, Lee Y, Lee T. Rapid Establishment of Tracheal Stenosis in Pigs Using Endotracheal Tube Cuff Overpressure and Electrocautery. Curr Med Sci 2021; 41:329-335. [PMID: 33877550 DOI: 10.1007/s11596-021-2351-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022]
Abstract
To apply a new airway treatment to humans, preclinical studies in an appropriate animal model is needed. Canine, porcine and leporine tracheas have been employed as animal airway stenosis models using various methods such as chemical caustic agents, laser, and electrocautery. However, existing models take a long time to develop (3-8 weeks) and the mechanism of stenosis is different from that in humans. The aim of the present study was to establish a new and fast tracheal stenosis model in pigs using a combination of cuff overpressure intubation (COI) and electrocautery. Fourteen pigs were divided into three groups: tracheal cautery (TC) group (n=3), COI group (n=3), and COI-TC combination group (n=8). Cuff overpressure (200/400/500 mmHg) was applied using a 9-mm endotracheal tube. Tracheal cautery (40/60 watts) was performed using a rigid bronchoscopic electrocoagulator. After intervention, the pigs were observed for 3 weeks and bronchoscopy was performed every 7 days. When the cross-sectional area decreased by > 50%, it was confirmed that tracheal stenosis was established. The time for tracheal stenosis was 14 days in the TC group and 7 days in the COI-TC combination group. In the COI group, no stenosis occurred. In the COI-TC group, electrocautery (40 watts) immediately after intubation for >1 h with a cuff pressure of 200 mmHg or more resulted in sufficient tracheal stenosis within 7 days. Moreover, the degree of tracheal stenosis increased in proportion to the cuff pressure and tracheal intubation time. The combined use of cuff overpressure and electrocautery helped to establish tracheal stenosis in pigs rapidly.
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Affiliation(s)
- Jin Hyoung Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 44033, Korea
| | - Jong Joon Ahn
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 44033, Korea
| | - Yangjin Jegal
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 44033, Korea
| | - Soohyun Bae
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 44033, Korea
| | - Soon Eun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 44033, Korea
| | - Moon Sik Jung
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 44033, Korea
| | - Ju Ik Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 44033, Korea
| | - Hee Jeong Cha
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 44033, Korea
| | - Yongjik Lee
- Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 44033, Korea.
| | - Taehoon Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 44033, Korea.
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Jin B, Wang T, Wang Y, Zhang J. Montgomery T-Tube Insertion Under ECMO in a Patient With Complete Subglottic Stenosis and Severe Lower Tracheal Collapse. EAR, NOSE & THROAT JOURNAL 2021; 102:NP223-NP225. [PMID: 33764200 DOI: 10.1177/01455613211006010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The treatment of complete subglottic stenosis (SGS) remains a challenge due to anatomic and technological limitations. Placement of the Montgomery T-tube is an effective treatment option. For complete SGS patient combined with lower trachea collapse, the ventilation management during the T-tube insertion process is more complicated. Here, we report a case with complete SGS combined with severe lower trachea collapse, which was successfully managed with T-tube insertion under extracorporeal membrane oxygenation.
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Affiliation(s)
- Beibei Jin
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, China
| | - Yuling Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, China
| | - Jie Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, China
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Multimodality Surgical Approach in Management of Laryngotracheal Stenosis. Case Rep Otolaryngol 2018; 2018:4583726. [PMID: 29808149 PMCID: PMC5902080 DOI: 10.1155/2018/4583726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/28/2018] [Accepted: 03/17/2018] [Indexed: 01/12/2023] Open
Abstract
Introduction Postintubation laryngotracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngotracheal stenosis secondary to long-term intubation/tracheostomy with review of the literature. Materials and Methods In this retrospective study, we present 5 cases (a 23-year-old male, 13-year-old male, 22-year-old male, 19-year-old male, and 33-year-old female) of postintubation/tracheostomy laryngotracheal (glottic/subglottic) stenosis in the years 2016 and 2017. Each patient was managed differently. Intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. Results The site of stenosis was in the subglottis in 4 patients and glottis in 1 patient. The mean length of the stenosis was greater in the postintubation group. Postintubation stenosis had a mean duration of intubation of 6.8 days, compared to 206.25 days of cannulation following tracheostomies. Each patient underwent an average of 2 procedures during their treatment course. One patient underwent open surgical anastomosis because of recurrent subglottic stenosis after multiple treatments. Phonation improved immediately in almost all except in the patient who underwent only endoscopic dilatation. Discussion The reasons for laryngeal stenosis and its delayed diagnosis have been reviewed from the literature. Suture tension should be appropriate, and placement of the suture knot outside the trachea minimizes formation of granulation tissue. The published reports suggest that resection by endoscopy with laser and open technique resection and primary anastomosis are the best treatment modality so far as the long-term results are concerned. Conclusion Resection of stenotic segment by open surgical anastomosis and laser-assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.
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Prasad KT, Dhooria S, Sehgal IS, Aggarwal AN, Agarwal R. Complete subglottic tracheal stenosis managed with rigid bronchoscopy and T-tube placement. Lung India 2016; 33:661-663. [PMID: 27890997 PMCID: PMC5112825 DOI: 10.4103/0970-2113.192879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Surgery is the preferred treatment modality for benign tracheal stenosis. Interventional bronchoscopy is used as a bridge to surgery or in instances when surgery is not feasible or has failed. Stenosis in the subglottic trachea is particularly a treatment challenge, in view of its proximity to the vocal cords. Herein, we describe a patient with complete tracheal stenosis in the subglottic region, which developed after prolonged intubation and mechanical ventilation. The patient developed recurrent stenosis despite multiple surgical and endoscopic procedures. We were able to manage the patient successfully with rigid bronchoscopy and Montgomery T-tube placement.
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Affiliation(s)
- Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Liu J, Zhang CP, Li Y, Dong S. Post-intubation tracheal stenosis after management of complicated aortic dissection: a case series. J Cardiothorac Surg 2015; 10:148. [PMID: 26537875 PMCID: PMC4632458 DOI: 10.1186/s13019-015-0357-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/28/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients undergoing total aortic arch replacement or aortic dissecting aneurysmectomy are generally managed with medications to control hypotension and blood coagulation to minimize mortality and morbidity. However, prolonged mechanical ventilation via tracheal intubation increases the risk of tracheal stenosis in such patients. CASE PRESENTATION We present 2 cases (a 49-year-old woman and a 62-year-old man) of post-intubation tracheal stenosis occurring after surgery for the correction of complicated aortic dissection; both cases were successfully managed by tracheal cryotherapy. CONCLUSION Continuous monitoring of cuff pressure and regular cuff palpation are necessary to minimize the incidence of tracheal stenosis. If the patients have concomitant local or systemic infection, adequate preventive measures should be taken to reduce the incidence of post-intubation tracheal stenosis. Tracheal cryotherapy is recommendable for the management of post-intubation tracheal stenosis.
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Affiliation(s)
- Jia Liu
- Department of Thyroid Surgery, First hospital of Jilin University, Changchun, Jilin, China.
| | - Chun-Peng Zhang
- Department of Cardiovascular Surgery, First hospital of Jilin University, Changchun, Jilin, China.
| | - Ye Li
- Department of Radiology, First hospital of Jilin University, Changchun, Jilin, China.
| | - Su Dong
- Department of Anesthesia, First hospital of Jilin University, No.71st Xinmin ST, Changchun, Jilin, 130021, China.
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