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Bajad P, Pahuja S, Agarwal S, Khanna A. Swiss Cheese Trachea: An Unwarranted, Unique Form of Post-intubation Tracheal Stenosis. Indian J Crit Care Med 2024; 28:84-85. [PMID: 38510770 PMCID: PMC10949288 DOI: 10.5005/jp-journals-10071-24611] [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] [Indexed: 03/22/2024] Open
Abstract
How to cite this article: Bajad P, Pahuja S, Agarwal S, Khanna A. Swiss Cheese Trachea: An Unwarranted, Unique Form of Post-intubation Tracheal Stenosis. Indian J Crit Care Med 2024;28(1):84-85.
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Affiliation(s)
- Pradeep Bajad
- Department of Pulmonary Medicine, School of Medicine, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, India
| | - Sourabh Pahuja
- Department of Pulmonary Medicine, School of Medicine, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, India
| | - Satyam Agarwal
- Department of Pulmonary Medicine, School of Medicine, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, India
| | - Arjun Khanna
- Department of Pulmonary Medicine, School of Medicine, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, India
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2
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Chrissian AA, Diaz-Mendoza J, Simoff MJ. Restenosis Following Bronchoscopic Airway Stenting for Complex Tracheal Stenosis. J Bronchology Interv Pulmonol 2023; 30:268-276. [PMID: 35856939 DOI: 10.1097/lbr.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonsurgical patients with complex postintubation tracheal stenosis (PITS) and tracheostomy-associated tracheal stenosis (PTTS) often require airway stenting. However, the optimal approach is unknown. Identifying patients at higher risk for restenosis after stent removal may allow the treating physician to individualize the vigilance and duration of airway stenting, and help optimize outcomes. METHODS This was a single-center retrospective analysis of prospectively collected data on all patients with complex PITS and/or PTTS treated with protocolized bronchoscopic airway stenting over a consecutive 16-year period. The primary outcome analyzed was restenosis rate at 1 year after stent removal. Predictors for restenosis and factors influencing risk for death during stent therapy were also assessed. RESULTS Of the 181 subjects treated with silicone airway stenting, 128 were available for analysis of the primary outcome. Restenosis by 1 year after stent removal occurred in 58%. Independent predictors for restenosis were coexisting diabetes [odd ratio (OR)=3.10, 95% confidence interval (CI)=1.04-9.24; P =0.04], morbid obesity (OR=3.13, 95% CI=1.20-8.17; P =0.02), and occurrence of stent-associated complications requiring bronchoscopic management (OR=2.13, 95% CI=1.12-4.03; P =0.02). The overall mortality during the initial stenting period was 14%, and a silicone Y-stent was associated with a higher risk of death (OR=3.58, 95% CI=1.40-9.14; P =0.008). CONCLUSION Tracheal restenosis after silicone stent therapy for complex PITS and PTTS is common and more likely to occur in patients with diabetes, morbid obesity, and frequent stent-associated complications. Mortality risk during stent therapy is not negligible, and a Y-stent should be utilized only after careful consideration. These findings may be incorporated into the approach to bronchoscopic airway stenting in these patients.
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Affiliation(s)
- Ara A Chrissian
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy, and Sleep Medicine, Loma Linda University, Loma Linda, CA
| | - Javier Diaz-Mendoza
- Division of Pulmonary and Critical Care, Interventional Pulmonology Section, Henry Ford Hospital
- Department of Internal Medicine, Wayne State University, Detroit, MI
| | - Michael J Simoff
- Division of Pulmonary and Critical Care, Interventional Pulmonology Section, Henry Ford Hospital
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3
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Deng M, Wang M, Zhang Q, Jiang B, Yan L, Bian Y, Hou G. Point-of-care ultrasound-guided submucosal paclitaxel injection in tracheal stenosis model. J Transl Int Med 2023; 11:70-80. [PMID: 37533845 PMCID: PMC10393055 DOI: 10.2478/jtim-2022-0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Background and Objectives Transcutaneous point-of-care ultrasound (POCUS) is a good tool to monitor the trachea in many clinical practices. The aim of our study is to verify the feasibility of POCUS-guided submucosal injection as a potential drug delivery method for the treatment of tracheal stenosis. Materials and methods The inner wall of the trachea was monitored via a bronchoscope during the POCUS-guided submucosal injection of methylene blue in fresh ex vivo porcine trachea to evaluate the distribution of methylene blue. The feasibility and eficacy of POCUS-guided submucosal injection were evaluated in a tracheal stenosis rabbit model. Animals were divided into sham group, tracheal stenosis group, and treatment group. Ten days after the scraping of the tracheal mucosa or sham operation, POCUS-guided submucosal injection of paclitaxel or saline was performed. Seven days after the submucosal injection, the trachea was assessed by cervical computed tomography (CT) scan and ultrasound. Results The distribution of methylene blue in trachea proved the technical feasibility of POCUS-guided submucosal injection. CT evaluation revealed that the tracheal stenosis index and the degree of tracheal stenosis increased significantly in the stenosis group, while POCUS-guided submucosal injection of paclitaxel partially reversed the tracheal stenosis. POCUS-guided submucosal injection of paclitaxel also decreased the lamina propria thickness and collagen deposition in the stenosed trachea. Conclusion POCUS-guided submucosal paclitaxel injection alleviated tracheal stenosis induced by scraping of the tracheal mucosa. POCUS-guided submucosal injection might be a potential method for the treatment of tracheal stenosis.
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Affiliation(s)
- Mingming Deng
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing100029, China
| | - Mengchan Wang
- Department of Respiratory and Critical Care Medicine, First Hospital of China Medical University, Shenyang110002, Liaoning Province, China
| | - Qin Zhang
- Department of Respiratory and Critical Care Medicine, First Hospital of China Medical University, Shenyang110002, Liaoning Province, China
| | - Bin Jiang
- Department of Ultrasound, First Hospital of China Medical University, Shenyang110002, Liaoning Province, China
| | - Liming Yan
- Department of Respiratory and Critical Care Medicine, Fourth Hospital of China Medical University, Shenyang110033, Liaoning Province, China
| | - Yiding Bian
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing100029, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing100029, China
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Castillo-Ortega G, Ibarra-Celaya JM, Leyva-Moraga F, Leyva-Moraga FA, Leyva-Moraga E, Ocejo-Gallegos JA, Valenzuela-García C. Post-intubation double tracheal stenosis. Indian J Thorac Cardiovasc Surg 2023; 39:204-206. [PMID: 36785613 PMCID: PMC9918691 DOI: 10.1007/s12055-022-01426-y] [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: 07/02/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 02/11/2023] Open
Abstract
Post-intubation tracheal stenosis is a condition that can occur as a consequence of tracheostomy or prolonged intubation. The development of two levels of airway narrowing is rare. We present the case of a 43-year-old male with a history of prolonged mechanical ventilation, who presented to our center with progressive respiratory impairment. Computed tomography with three-dimensional reconstruction demonstrated complex tracheal anatomy with double-level stenosis. The patient underwent successful endoscopic procedure. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-022-01426-y.
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Affiliation(s)
| | | | - Fernando Leyva-Moraga
- Department of Medicine and Health Sciences, Universidad de Sonora, Hermosillo, México
| | | | - Eduardo Leyva-Moraga
- Department of Medicine and Health Sciences, Universidad de Sonora, Hermosillo, México
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Badovinac S, Popović F, Glodić G, Baričević D, Srdić D, Džubur F, Koršić M, Samaržija M. Tracheal complications of mechanical ventilation for COVID-19: a plot twist for survivors. ERJ Open Res 2023; 9:00478-2022. [PMID: 36879905 PMCID: PMC9885244 DOI: 10.1183/23120541.00478-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/28/2022] [Indexed: 01/27/2023] Open
Abstract
Tracheal complications should be suspected in mechanically ventilated COVID-19 survivors with respiratory symptoms. Treatment requires a multimodal approach of interventional bronchoscopy and surgery with tight follow-up due to a high rate of restenosis. https://bit.ly/3iw05xQ.
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Affiliation(s)
- Sonja Badovinac
- Clinic for Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Filip Popović
- Clinic for Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Goran Glodić
- Clinic for Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Denis Baričević
- Clinic for Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dražena Srdić
- Clinic for Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Feđa Džubur
- Clinic for Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marta Koršić
- Clinic for Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miroslav Samaržija
- Clinic for Lung Diseases Jordanovac, University Hospital Centre Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Rorris FP, Chatzimichali E, Liverakou E, Antonopoulos CN, Balis E, Kotsifas C, Stratakos G, Koutsoukou A, Zisis C. Tracheal resection in post COVID-19 patients is associated with high reintervention rate and early restenosis. JTCVS Tech 2023; 18:157-163. [PMID: 36685052 PMCID: PMC9846877 DOI: 10.1016/j.xjtc.2023.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/21/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives A remarkable increase in the number of patients presenting with tracheal complications after prolonged endotracheal intubation and mechanical ventilation for the management of the severe COVID-19 - associated respiratory failure has been observed. In this study, we assessed the postoperative outcomes of tracheal resection in COVID-19 patients. Methods We conducted a retrospective study in which all patients with a history of prolonged invasive mechanical ventilation due to COVID-19 infection, who were treated with tracheal resection and reconstruction, were included. The primary objective was in-hospital mortality and postoperative reintervention rate. The secondary objective was the time to tracheal restenosis. Results During the 16-month study period, 11 COVID-19 patients with tracheal complications underwent tracheal resection with end-to-end anastomosis. Mean patient age was 51.5 ± 9 years, and the majority were male (9 patients). Eight patients were referred for management of post-intubation tracheal stenosis and 3 for tracheoesophageal fistula. Eight patients had a history of tracheostomy during the COVID-19 infection hospitalization. There was one in-hospital death (9.1%) due to septicemia in the Intensive Care Unit, approximately two months after the operation. Postoperatively, 32 reinterventions were required for tracheal restenosis due to granulation tissue formation. The risk for reintervention was higher during the first 3 months after the index operation. Four patients developed tracheal restenosis (36.4%) and two of them required endotracheal stent placement during the follow up period. Conclusions Tracheal resection and reconstruction after COVID-19 infection is associated with a high reintervention rate postoperatively. Such patients require close follow up in expert interventional pulmonology units and physicians should be on high alert for the early diagnosis and optimal management of tracheal restenosis.
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Affiliation(s)
- Filippos-Paschalis Rorris
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece,Address for reprints: Filippos-Paschalis Rorris, MD, Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Ypsilantou 45-47, Athens, 106 76, Greece
| | - Evangelia Chatzimichali
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece
| | - Evangelia Liverakou
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece
| | - Constantine N. Antonopoulos
- Department of Vascular Surgery, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Balis
- Department of Interventional Pulmonology, Evangelismos General Hospital, Athens, Greece
| | - Constantinos Kotsifas
- Department of Interventional Pulmonology, Evangelismos General Hospital, Athens, Greece
| | - Grigoris Stratakos
- Department of Interventional Pulmonology, 1st Department of Pulmonology, Medical School, University of Athens, “Sotiria” Hospital, Athens, Greece
| | - Antonia Koutsoukou
- Department of Interventional Pulmonology, 1st Department of Pulmonology, Medical School, University of Athens, “Sotiria” Hospital, Athens, Greece
| | - Charalampos Zisis
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece
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Ming W, Zuo J, Han J, Chen J. The efficiency of endoscopic versus open surgical interventions in adult benign laryngotracheal stenosis: a meta-analysis. Eur Arch Otorhinolaryngol 2022; 280:2421-2433. [PMID: 36585989 DOI: 10.1007/s00405-022-07797-7] [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: 08/17/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The optimal treatments for adult benign laryngotracheal stenosis presently remains controversial. The majority of the disadvantages of endoscopic interventions with high recurrence rate and open surgical therapy accompanied by sophisticated techniques, complication and mortality, highlights the dilemma of option for treatments. PURPOSE To compare endoscopic treatments with open surgical interventions in adult patients with benign laryngotracheal stenosis, analyze their clinical outcomes, recurrence, complication and mortality. METHODS In the meta-analysis, the databases including PubMed, Embase, Ovid and Web of Science were searched for studies reporting adult benign laryngotracheal stenosis, and clinical outcomes were compared. The duplicate publications, reviews, comments or letters, conference abstracts, case reports were excluded. The random effect model was used for calculating the pooled effect estimates. RESULTS Eight studies (1627 cases) referring to six retrospective and two prospective researches were ultimately included in the meta-analysis. The decreased risk estimates of recurrence rate in patients receiving open surgical interventions were detected, comparing with endoscopic interventions (P < 0.05). Subgroup analysis revealed that decreased risk estimates of restenosis rate were also observed in patients receiving open surgical interventions compared with endoscopic interventions (P < 0.05), based on prospective studies, Europe and America, < 2-year follow-up, laryngeal stenosis, stenotic length without inter-group difference or stenotic grade II alone. However, there were no statistically significant difference of recurrence rate between the two interventions (P > 0.05) based on retrospective studies, South Asia and Africa, ≥ 2-year follow-up, involving tracheal lesion, stenotic length with inter-group difference, or stenotic grades of I-IV. No notable difference in the incidence of complication or mortality were identified. CONCLUSIONS Open surgical interventions were more suitable for most laryngotracheal stenosis without contraindications. Endoscopic interventions are increasingly being used to treat simple laryngotracheal stenosis, as well as complex airway stenosis in carefully selected cases. Multi-center prospective randomized controlled trials should be conducted to search for the standard treatments for laryngotracheal stenosis.
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Affiliation(s)
- Wei Ming
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Jingjing Zuo
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jibo Han
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jinhui Chen
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Gu L, Li A, Lin J, Gan Y, He C, Xiao R, Liao J, Li Y, Guo S. Knockdown of SOX9 alleviates tracheal fibrosis through the Wnt/β-catenin signaling pathway. J Mol Med (Berl) 2022; 100:1659-1670. [PMID: 36192639 DOI: 10.1007/s00109-022-02261-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/30/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
Trachealfibrosis is an important cause of tracheal stenosis without effective treatments, and new drug targets need to be developed. The role of SOX9 in the injury and repair of the trachea is unknown; this study aims to investigate the role of SOX9 in the regulation of tracheal fibrosis based on clinical samples from patients with tracheal injury and a model of tracheal fibrosis produced by tracheal brushing in rats. The results showed that the expressions of SOX9 and mesenchymal and ECM-related indicators were increased in the injury and fibrosis of the trachea in patients and rats. Serum SOX9 levels exhibited a sensitivity of 83.87% and specificity of 90% in distinguishing patients with tracheal fibrosis from healthy volunteers when the cut‑off value was 13.24 ng/ml. Knockdown SOX9 can markedly inhibit granulation tissue proliferation, reduce inflammation and ECM deposition, promote epithelial regeneration and granulation tissue apoptosis, and attenuate the tracheal fibrosis after injury. Additionally, RNA sequencing showed that the proliferation, migration, and ECM deposition of tracheal granulation tissue were related to the activation of Wnt pathway, activation of the β-catenin, and p-GSK3β after injury can be inhibited by the knockdown of SOX9. In summary, SOX9 is upregulated in tracheas fibrosis and may be a novel factor to promote tracheal fibrosis progression. Inhibiting SOX9 may be used to prevent and treat tracheal fibrosis in the future. KEY MESSAGE : The expression of SOX9 is upregulated the process of injury and repair of the tracheal fibrosis. Knocking down SOX9 can attenuate tracheal fibrosis after injury by inhibiting inflammation response, granulation tissue proliferation, ECM deposition, and promoting granulation tissue apoptosis. The Wnt/β-catenin-SOX9 axis is activated during tracheal injury and fibrosis, and inhibition of SOX9 can partially alleviate tracheal fibrosis. SOX9 may act as a new diagnostic and therapeutic target in patients with tracheal fibrosis in the future.
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Affiliation(s)
- Lei Gu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Anmao Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jing Lin
- Department of Infection Disease, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yiling Gan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Chunyan He
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Rui Xiao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jiaxin Liao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
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Ayten O, Iscanli IGE, Canoglu K, Ozdemir C, Saylan B, Caliskan T, Akin H, Tezel C. Tracheal Stenosis After Prolonged Intubation Due to COVID-19. J Cardiothorac Vasc Anesth 2022; 36:2948-2953. [PMID: 35283040 PMCID: PMC8832874 DOI: 10.1053/j.jvca.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 01/01/2023]
Abstract
Objectives The authors aimed to evaluate the characteristics and management outcomes of patients who developed tracheal stenosis after invasive mechanical ventilation (IMV) due to COVID-19. Design, Setting, and Participants The data of 7 patients with tracheal stenosis and 201 patients without tracheal stenosis after IMV due to COVID-19 between March 2020 and October 2021 were retrospectively analyzed. Interventions Flexible bronchoscopy was performed for the diagnosis of tracheal stenosis and the evaluation of the treatment's effectiveness, and rigid bronchoscopy was applied for the dilatation of tracheal stenosis. Measurements and Main Results In the follow-up period, tracheal stenosis was observed in 7 of 208 patients (2 women, 5 men; 3.3%). The patients were divided into 2 groups as patients with tracheal stenosis (n = 7) and patients without tracheal stenosis (n = 201). There were no statistically significant differences between the 2 groups in terms of age, sex, body mass index, and comorbidities (p > 0.05). The mean duration of IMV of the patients with tracheal stenosis was longer than patients without tracheal stenosis (27.9 ± 13 v 11.2 ± 9 days, p < 0.0001, respectively). Three (43%) of the stenoses were web-like and 4 (57%) of them were complex-type stenosis. The mean length of the stenoses was 1.81 ± 0.82 cm. Three of the patients were treated successfully with bronchoscopic dilatation, and 4 of them were treated with tracheal resection. Conclusions Tracheal stenosis developed in 7 of 208 (3.3%) patients with COVID-19 who were treated with IMV. The most important characteristic of patients with tracheal stenosis was prolonged IMV support.
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Affiliation(s)
- Omer Ayten
- Department of Pulmonary Medicine, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey.
| | - Insa Gul Ekiz Iscanli
- Department of Intensive Care Unit, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey
| | - Kadir Canoglu
- Department of Pulmonary Medicine, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey
| | - Cengiz Ozdemir
- Department of Pulmonary Medicine, Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Istanbul, Turkey
| | - Bengü Saylan
- Department of Pulmonary Medicine, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey
| | - Tayfun Caliskan
- Department of Pulmonary Medicine, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey
| | - Hasan Akin
- Department of Thoracic Surgery, Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Istanbul, Turkey
| | - Cağatay Tezel
- Department of Thoracic Surgery, Sultan Abdulhamid Han Teaching Hospital, Istanbul, Turkey
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The Role of Bronchoscopy in the Diagnosis and Management of Patients with SARS-Cov-2 Infection. Diagnostics (Basel) 2021; 11:diagnostics11101938. [PMID: 34679633 PMCID: PMC8534996 DOI: 10.3390/diagnostics11101938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/25/2023] Open
Abstract
Bronchoscopy has several major diagnostic and therapeutic indications in pulmonology. However, it is an aerosol-generating procedure that places healthcare providers at an increased risk of infection. Now more than ever, during the spread of the coronavirus disease 2019 (COVID-19) pandemic, the infectious risk during bronchoscopy is significantly raised, and for this reason its role in diagnostic management is debated. In this review, we summarized current evidence regarding the indications for bronchoscopy and the measures that should be applied to decrease risk exposure. Indeed, seeing the long-lasting period of the pandemic, resuming standard of care for all patients is required.
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11
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Piro R, Casalini E, Livrieri F, Fontana M, Ghidoni G, Taddei S, Facciolongo N. Interventional pulmonology during COVID-19 pandemic: current evidence and future perspectives. J Thorac Dis 2021; 13:2495-2509. [PMID: 34012596 PMCID: PMC8107537 DOI: 10.21037/jtd-20-2192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
COVID-19, caused by SARS-CoV-2 infection, has become increasingly prevalent worldwide, reaching a pandemic stage in March 2020. The organization of health care services had to change because of this new disease, with the need to reallocate staff and materials, besides changing management protocols. A very important challenge is not to expose patients and health care workers to the risk of infection and not to waste personal protective equipment (PPE). In the field of interventional pulmonology, various aspects related to COVID-19 must be taken into great consideration. Although bronchoscopy is not a first-line test for patients with suspected SARS-CoV-2 infection, it has a role in selected cases and it can be useful for differential diagnosis. However, bronchoscopy is an aerosol-generating procedure, that’s why its unjustified use could contribute to propagate the virus. For this reason, the utility of each procedure must be carefully evaluated, the patient has to be properly investigated before the procedure, which has to be performed with specific precautions, including adequate PPE. In this review, we summarize the knowledge and the principal statements about endoscopic activity in COVID-19 period, in both diagnosis of COVID-19 and management of patients. How to safely perform both bronchoscopic and pleural-related procedures (thoracoscopy, pleural biopsy and drainage of pleural effusions) is described with the aim to help the staff to decide when and how performing a procedure. We also highlight how interventional pulmonology could help in matter of complications related to COVID-19.
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Affiliation(s)
- Roberto Piro
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Eleonora Casalini
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Francesco Livrieri
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Matteo Fontana
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Giulia Ghidoni
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Sofia Taddei
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Nicola Facciolongo
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
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Sun K, Zhang H, Zhang W, Cheng Y, Wang G. Long-term prognostic factors of clinical success after interventional bronchoscopy in patients with scarring central airway stenosis. BMC Pulm Med 2021; 21:73. [PMID: 33648488 PMCID: PMC7923499 DOI: 10.1186/s12890-021-01434-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background Scarring central airway stenosis (SCAS) is a potentially life-threatening condition with debilitating symptoms. Interventional bronchoscopy is increasingly used to relieve symptoms in patients with SCAS, but recurrent stenosis is frequently observed. Little data exist on the long-term prognosis of interventional bronchoscopy for SCAS. We aimed to assess the prognostic factors of bronchoscopic interventions in patients with SCAS to optimize treatment. Methods This was a retrospective study that enrolled 119 consecutive patients with SCAS from January 2010 to April 2019 at our institution. Long-term clinical success was defined as airway stenosis < 50%, no limitation of physical activity, and a stable condition for > 12 months after the last interventional procedure. We compared patients’ demographics, airway stenosis characteristics, and interventional procedures between the successful and unsuccessful groups, and identified significant predictors of long-term outcome with univariate and multivariate logistic regression. Results A total of 119 patients with 577 therapeutic bronchoscopies were included. Seventy-five (63%) patients were considered to have long-term clinical success. Older age, male gender, smoking, elevated C-reactive protein level, subglottic stenosis, stent or T-tube implantation, previous interventional treatment, and multiple procedures per year were potentially associated with unsuccessful long-term outcomes in the univariate analysis. Current smoker status (odds ratio [OR] 5.70, 95% confidence interval [CI] 1.35–24.17, P = 0.018), subglottic stenosis (OR 4.35, 95% CI 1.31–14.46, P = 0.017), and stent implantation (OR 4.96, 95% CI 1.33–18.48, P = 0.017) were associated with decreased odds of long-term success in the multivariate logistic regression analysis. Of note, there was no significant difference in odds of success between former smokers and nonsmokers. Conclusions Current smoker status, subglottic stenosis, and stent implantation are independent factors associated with reduced long-term efficacy of interventional bronchoscopy for SCAS. Smoking cessation should be encouraged to improve the outcome of therapeutic bronchoscopy. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01434-5.
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Affiliation(s)
- Kunyan Sun
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Hong Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yuan Cheng
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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