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Yousef A, Solomon I, Cheng G, Makani S, Boys J, Weissbrod PA. COVID-19 Related Tracheal Stenosis Requiring Tracheal Resection: A Case Series. Ann Otol Rhinol Laryngol 2024; 133:879-885. [PMID: 39127881 DOI: 10.1177/00034894241266489] [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] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To characterize the preoperative and intraoperative findings of symptomatic tracheal stenosis associated with COVID-19 related respiratory failure requiring tracheal resection. METHOD We performed a retrospective review identifying all patients with a history of tracheal stenosis secondary to COVID-19 related respiratory failure who subsequently received a tracheal resection at our institution between January 2020 and June 2023. Clinical, radiological, pathological, and surgical characteristics were recorded to describe and characterize pre-operative and intraoperative findings associated with tracheal stenosis in the setting of a previous COVID-19 infection. RESULTS We retrospectively reviewed 11 patients with COVID-19 related tracheal stenosis that required open tracheal or cricotracheal resection. The mean age was 54.1. Patients were hospitalized for a mean of 49.5 days related to COVID-19 complications. Tracheotomy was completed in 10 patients (90.9%) during their initial hospitalization with COVID-19 related respiratory failure. Patients were intubated a mean of 18.6 days prior to tracheotomy completion. Ten patients (90.9%) underwent endoscopic operative interventions for their tracheal stenosis prior to open resection. Intraoperatively, the mean stenosis length was 3.33 cm. The mean tracheal resection length was 3.96 cm. Patients were hospitalized for a mean of 8.27 days post operatively with no significant post operative complications. CONCLUSIONS Symptomatic tracheal stenosis in the setting of prolonged intubation due to COVID-19 is an under-described etiology. This is one of the largest single institution retrospective reviews that identifies 11 patients with prolonged intubation who developed symptomatic tracheal stenosis refractory to conservative management and ultimately requiring tracheal resection.
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Affiliation(s)
- Andrew Yousef
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, San Diego, CA, USA
| | - Isaac Solomon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, San Diego, CA, USA
| | - George Cheng
- Division of Pulmonology, Critical Care, Sleep Medicine and Physiology, University of California, San Diego, San Diego, CA, USA
| | - Samir Makani
- Department of Pulmonology and Critical Care Medicine, Scripps Hospital Encinitas, Encinitas, CA, USA
| | - Joshua Boys
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, USA
| | - Philip A Weissbrod
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, San Diego, CA, USA
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Alaga A, Simhan V, Lokeshwaran S, Kumar K S, Chetana Shanmukhappa S. Management of postintubation tracheal stenosis with bronchoscope methods-An experience from two centers. Respirol Case Rep 2024; 12:e70014. [PMID: 39247567 PMCID: PMC11381110 DOI: 10.1002/rcr2.70014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 08/19/2024] [Indexed: 09/10/2024] Open
Abstract
Tracheal stenosis is a common complication of endotracheal intubation or tracheostomy, resulting in significant morbidity and mortality. Bronchoscope interventions have been proposed as a safe alternative for the management of post-intubation post-intubation tracheal stenosis (PITS). Data for patients diagnosed with PITS across two hospitals, between 2021 and 2022, encompassing demographic, clinical, and procedural details were gathered from electronic medical records, and analysed. Primary outcomes centred on assessing the incidence and severity of PITS through bronchoscope examination and radiological imaging, and the efficacy of bronchoscope interventions, including stenting and the application of mitomycin C. Twelve patients were managed for PITS. Majority of patients were females (9/12) with mean age of 46.41 years. Presenting signs and symptoms were dyspnea, rhonchi and failed extubation, the mean duration of intubation/ tracheostomy is 16.41 days (range: 3-40 days). Most common comorbidity was type 2 diabetes, (5 patients, 41.6%). The lesions mean length was 3.09 cm and Cotton-Meyer Grade II and III. Prompt evaluation is crucial, in these patients. The Cotton-Meyer grade is pivotal in treatment decisions, with intubating times correlating with the severity of stenotic disease. Our case series demonstrates the increasing utility of bronchoscopy in managing these cases.
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Affiliation(s)
- Arvindran Alaga
- Pulmonology Department Hospital Sultanah Bahiyah Alor Setar Malaysia
| | | | | | - Sunil Kumar K
- Pulmonology Department Aster CMI Hospital Bangalore India
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Nisa L, Leroyer H, Sandu K. Open airway surgery for post-COVID laryngotracheal stenosis. Eur Arch Otorhinolaryngol 2024; 281:2531-2538. [PMID: 38407612 PMCID: PMC11024014 DOI: 10.1007/s00405-024-08533-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION This study reports our experience with open reconstructive surgery in patients with laryngotracheal stenosis (LTS) following prolonged intubation and/or tracheostomy in the context of COVID-19. METHODS All patients underwent a preoperative endoscopic airway assessment. Posterior glottic lesions were graded according to the Bogdasarian classification, subglottic-tracheal lesions according to the Cotton-Myers classification and postoperative complications reported by the Clavien-Dindo classification. We report postoperative outcomes and functional results in this patient subset. RESULTS We include 14 patients diagnosed to have post COVID LTS, one female and 13 males. This group was compared with a control group, diagnosed with LTS following prolonged intubation. In the COVID group, mean age of patients at the time of the airway surgery was 52.1 ± 16.8 years (range: 13.7-76.3). More than half the patients were multi-morbid with hypertension and obesity being the most common conditions. Eleven patients had multi-site stenoses. Open surgical interventions performed were tracheal resection and anastomosis, laryngotracheal reconstruction and extended cricotracheal resection, and postoperative complications were seen in 12 (85.6%) patients. 70% patients with pre-existing tracheostomy were decannulated. Oral swallowing was not tolerated in one-fifth of the patients and a significant number of them have poor voice quality. CONCLUSION Post-COVID pandemic, airway surgeons are seeing an increased number of patients with complex LTS, and we report significant postoperative complications in this patient subset. Decannulation rates, voice and swallowing results are poor in patients with glottic involvement as compared to isolated tracheal stenosis.
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Affiliation(s)
- Lluís Nisa
- Department of Otorhinolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Hajdi Leroyer
- Department of Otorhinolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Kishore Sandu
- Department of Otorhinolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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Molteni G, Dallari V, Segato E, Mattioli F. Post-Covid-19 Airway Stenosis: Tracheal Resection-Anastomosis Using The Tritube® Ventilation. Laryngoscope 2024; 134:897-900. [PMID: 37466298 DOI: 10.1002/lary.30859] [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: 02/06/2023] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023]
Abstract
We present a video of a tracheal resection and anastomosis performed on a patient affected by A-shaped tracheal stenosis. The condition was a consequence of a percutaneous tracheostomy following a Sars-Cov2 infection. Airways management during the surgery was obtained with the Tritube®, an innovative device with a very small lumen that combines stable lung parameters and good visualization of surgical field. Laryngoscope, 134:897-900, 2024.
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Affiliation(s)
- Gabriele Molteni
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Verona, Italy
| | - Virginia Dallari
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Verona, Italy
| | - Erika Segato
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Verona, Italy
| | - Francesco Mattioli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
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Mammana M, Verzeletti V, Baldi M, Schiavon M, Dell'Amore A, Rea F. Surgery for tracheal and laryngotracheal stenosis: a historical case series. Eur J Cardiothorac Surg 2024; 65:ezae026. [PMID: 38290793 DOI: 10.1093/ejcts/ezae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVES Benign (laryngo-)tracheal stenosis is a relatively rare pathology and its surgical treatment is performed only at few specialized centres. This study aims to investigate outcomes after (laryngo-)tracheal resection-anastomosis, to explore potential risk factors for postoperative complications and to assess whether, over a 33-year period, there were major changes in surgical indications, techniques or outcomes. METHODS Retrospective, single-centre review of all consecutive patients who underwent tracheal or laryngo-tracheal resection/anastomosis for benign pathologies from 1990 to 2023. RESULTS Overall, 211 patients underwent tracheal (149 patients, 70.6%) and laryngo-tracheal (62 patients, 29.4%) resection-anastomosis. Of these, 195 patients (93.8%) were affected by iatrogenic stenosis, while 13 (6.2%) suffered from idiopathic stenosis. The median length of stenosis was 25 mm (interquartile range 1-3, 20-30). The overall morbidity rate was 27.5%, while major morbidity occurred in 10.5% of cases. One patient (0.5%) died in the postoperative period. Glottic oedema (17 patients, 8.1%), granulations (12 patients, 5.7%) and restenosis (10 patients, 4.7%) were the main complications. The only independent risk factor for postoperative complications was the length of the resected airway (P = 0.019). In the latest half of the study period, an older median age was observed, and no patient with idiopathic tracheal stenosis underwent surgery. Postoperative outcomes were comparable between surgical eras. CONCLUSIONS Surgical treatment of (laryngo-)tracheal stenosis is challenging and should be performed by specialized centres. In our experience, morbidity and mortality rates were satisfactory, and in most cases, patients could breathe without tracheostomy. The length of the stenosis was the most significant risk factor for postoperative complications.
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Affiliation(s)
- Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Vincenzo Verzeletti
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Baldi
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Perroni G, Radovanovic D, Mondoni M, Mangiameli G, Giudici VM, Crepaldi A, Giatti V, Morenghi E, Stella GM, Pavesi S, Mantero M, Corsico AG, Spotti M, Premuda C, Mangili SA, Franceschi E, Narvena VM, Vanoni N, Pilocane T, Russo G, Di Marco F, Alloisio M, Aliberti S, Marulli G, Bertuzzi AF, Cipolla G, Centanni S, Blasi F, Santus P, Cariboni U. Incidence of Tracheal Stenosis in ICU Hospitalized COVID-19 Patients: Results from a Prospective, Observational, Multicenter Study. J Pers Med 2023; 14:39. [PMID: 38248740 PMCID: PMC10817429 DOI: 10.3390/jpm14010039] [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: 12/11/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Tracheal stenosis represents a fearsome complication that substantially impairs quality of life. The recent SARS-CoV-2 pandemic increased the number of patients requiring invasive ventilation through prolonged intubation or tracheostomy, increasing the risk of tracheal stenosis. Study design and methods: In this prospective, observational, multicenter study performed in Lombardy (Italy), we have exanimated 281 patients who underwent prolonged intubation (more than 7 days) or tracheostomy for severe COVID-19. Patients underwent CT scan and spirometry 2 months after hospital discharge and a subsequent clinical follow-up after an additional 6 months (overall 8 months of follow-up duration) to detect any tracheal lumen reduction above 1%. The last follow-up evaluation was completed on 31 August 2022. Results: In the study period, 24 patients (8.5%, CI 5.6-12.4) developed tracheal stenosis in a median time of 112 days and within a period of 200 days from intubation. Compared to patients without tracheal stenosis, tracheostomy was performed more frequently in patients that developed stenosis (75% vs 54%, p = 0.034). Tracheostomy and alcohol consumption (1 unit of alcohol per day) increased risk of developing tracheal stenosis of 2.6-fold (p = 0.047; IC 0.99-6.8) and 5.4-fold (p = 0.002; CI 1.9-16), respectively. Conclusions: In a large cohort of patients, the incidence of tracheal stenosis increased during pandemic, probably related to the increased use of prolonged intubation. Patients with histories of prolonged intubation should be monitored for at least 200 days from invasive ventilation in order to detect tracheal stenosis at early stage. Alcohol use and tracheostomy are risk factors for developing tracheal stenosis.
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Affiliation(s)
- Gianluca Perroni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
| | - Dejan Radovanovic
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy; (M.M.); (S.P.)
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Veronica Maria Giudici
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Alessandro Crepaldi
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
| | - Valentina Giatti
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
| | - Emanuela Morenghi
- Biostatistics Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Giulia Maria Stella
- Department of Internal Medicine and Medical Therapeutics, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (G.M.S.); (A.G.C.)
- Unit of Respiratory Diseases, Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Stefano Pavesi
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy; (M.M.); (S.P.)
| | - Marco Mantero
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Angelo Guido Corsico
- Department of Internal Medicine and Medical Therapeutics, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (G.M.S.); (A.G.C.)
- Unit of Respiratory Diseases, Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Maura Spotti
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Chiara Premuda
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | | | - Elisa Franceschi
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | | | - Nicolò Vanoni
- Unit of Pneumology, ASST Lodi, 26900 Lodi, Italy; (N.V.); (G.C.)
| | - Tommaso Pilocane
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Gianluca Russo
- Unit of Pain Medicine, Department of Emergency, ASST Lodi, 26900 Lodi, Italy;
| | - Fabiano Di Marco
- Department of Health Sciences, Università degli Studi di Milano, Pneumologia, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
- Unit of Pneumology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Giuseppe Marulli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | | | - Giuseppe Cipolla
- Unit of Pneumology, ASST Lodi, 26900 Lodi, Italy; (N.V.); (G.C.)
| | - Stefano Centanni
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
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Piazza C, Lancini D, Zigliani G, Del Bon F, Tomasoni M, Montenegro C, Rampinelli V, Mattavelli D. Hemicricoidectomy with modified rotational thyro-crico-tracheal anastomosis: a newborn in the family of crico-tracheal resection and anastomosis techniques. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:382-389. [PMID: 37814978 PMCID: PMC10773548 DOI: 10.14639/0392-100x-n2623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 10/11/2023]
Abstract
Objective The aim of the present study is to describe our novel surgical technique of hemicricoidectomy and reconstruction with modified rotational thyro-crico-tracheal anastomosis for the treatment of non-squamous cell subglottic tumours. The procedure has been defined as Type E crico-tracheal resection and anastomosis (CTRA) following the University of Brescia (C)TRA classification introduced elsewhere. Methods A detailed anatomical step-by-step dissection was reproduced and illustrated on a cadaveric laryngo-tracheal specimen. Moreover, oncological and functional outcomes of the first 5 patients who underwent Type E CTRA at our Institution between October 2016 and September 2022 are described. Results Three patients underwent Type E CTRA for cricoid chondrosarcoma (CS) and 2 patients for subglottic adenoid cystic carcinoma (ACC). No post-operative complication was reported. All patients maintained intact oral intake and an intelligible voice at discharge. All but one patient with obstructive sleep apnoea hypopnea syndrome and lung comorbidity were successfully decannulated before discharge. At the last follow-up (April 2023), one patient experienced local recurrence of CS that was still amenable to conservative treatment by transoral debulking, while the remaining patients were free of disease. Conclusions With the proper indications, Type E CTRA is a feasible and effective conservative surgical technique for selected non-squamous cell subglottic tumours.
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Affiliation(s)
- Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Zigliani
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Claudia Montenegro
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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Fiz I, Filauro M, Sampieri C, Ioppi A, Vallin A, Fiz F, Koelmel JC, Lancini D, Piazza C, Sittel C, Peretti G. Analysis of Complications in (Crico-) Tracheal Resection Anastomosis in Adults: A Multicenter Study. Laryngoscope 2023; 133:2910-2919. [PMID: 36883671 DOI: 10.1002/lary.30635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES The gold standard treatments for advanced laryngotracheal stenosis (LTS) are represented by partial crico-tracheal (PCTRA) or tracheal resection and anastomosis (TRA). These procedures are potentially burdened by high postoperative complication rates. We investigated the impact of the most common stenosis and patient-related characteristics on the onset of complications in a multicentric cohort. METHODS We retrospectively analyzed patients who underwent PCTRA or TRA for LTS of different etiologies in three referral centers. We tested the effectiveness of these procedures, the impact of complications on the outcomes, and identified factors causing postoperative complications. RESULTS A total of 267 patients were included in the study (130 females; mean age, 51.46 ± 17.64 years). The overall decannulation rate was 96.4%. Altogether, 102 (38.2%) patients presented at least one complication, whereas 12 (4.5%) had two or more. The only independent predictor of post-surgical complications was the presence of systemic comorbidities (p = 0.043). Patients experiencing complications needed additional surgery more frequently (70.1% vs. 29.9%, p < 0.001), and had a longer duration of hospitalization (20 ± 10.9 vs. 11.3 ± 4.1 days, p < 0.001). Six of 102 (5.9%) patients with complications had restenosis, although this event did not occur among patients without complications. CONCLUSION PCTRA and TRA have an excellent success rate even when performed for high-grade LTS. However, a significant percentage of patients may experience complications associated with a longer duration of hospitalization or the need for additional surgeries. The presence of medical comorbidities was independently related to an increased risk of complications. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2910-2919, 2023.
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Affiliation(s)
- Ivana Fiz
- Department of Otorhinolaryngology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Filauro
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Claudio Sampieri
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Ioppi
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alberto Vallin
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Francesco Fiz
- Nuclear Medicine Department, Ente Ospedaliero "Ospedali Galliera", Genoa, Italy
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital, Tübingen, Germany
| | - Jan Costantin Koelmel
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Davide Lancini
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Christian Sittel
- Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Giorgio Peretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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9
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Hernández-García E, Hernández-Sandemetrio R, Quintana-Sanjuás A, Zapater-Latorre E, González-Herranz R, Sanz L, Reboll R, Pallarés-Martí B, Ollé-Moliner M, Martínez-Pascual P, Gotxi I, Chacón-Uribe A, Plaza G. Laryngotracheal Complications after Intubation for COVID-19: A Multicenter Study. Life (Basel) 2023; 13:life13051207. [PMID: 37240852 DOI: 10.3390/life13051207] [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: 02/27/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Many of the patients with COVID-19 have suffered respiratory distress requiring prolonged endotracheal intubation (ETI) resulting in laryngotracheal complication with an impact on breathing, phonation, and swallowing. Our aim is to describe laryngeal injuries diagnosed after ETI in patients with COVID-19 in a multicentre study. METHODS A prospective descriptive observational study was conducted from January 2021 to December 2021, including COVID-19 patients with laryngeal complications due to ETI diagnosed in several Spanish hospitals. We analyzed the epidemiological data, previous comorbidities, mean time to ICU admission and ETI, need for tracheostomy, mean time on invasive mechanical ventilation until tracheostomy or weaning, mean time in ICU, type of residual lesions, and their treatment. RESULTS We obtained the collaboration of nine hospitals during the months of January 2021 to December 2021. A total of 49 patients were referred. Tracheostomy was performed in 44.9%, being late in most cases (more than 7-10 days). The mean number of days of ETI until extubation was 17.63 days, and the main post-intubation symptoms were dysphonia, dyspnea, and dysphagia, in 87.8%, 34.7%, and 42.9%, respectively. The most frequent injury was altered laryngeal mobility, present in 79.6%. Statistically, there is a greater amount of stenosis after late ETI and after delayed tracheostomy, not observing the data with the immobility alterations. CONCLUSION The mean number of days of ETI was long, according to the latest guidelines, with the need for several cycles of pronation. This long ETI may have had an impact on the increase of subsequent laryngeal sequelae, such as altered laryngeal mobility or stenosis.
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Affiliation(s)
- Estefanía Hernández-García
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
| | | | - Ana Quintana-Sanjuás
- Department of Otorhinolaryngology, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain
| | | | - Ramón González-Herranz
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
| | - Lorena Sanz
- Department of Otorhinolaryngology, Hospital Universitario Torrejón, 28850 Madrid, Spain
| | - Rosa Reboll
- Department of Otorhinolaryngology, Hospital Universitario Sagunto, 46115 Valencia, Spain
| | - Beatriz Pallarés-Martí
- Department of Otorhinolaryngology, Consorci Corporació Sanitaria Parc Taulí Sabadell, 08208 Sabadell, Spain
| | | | - Paula Martínez-Pascual
- Department of Otorhinolaryngology, Hospital Universitario Severo Ochoa, 28914 Madrid, Spain
| | - Itziar Gotxi
- Department of Otorhinolaryngology, Hospital de Galdakao-Usansolo, 48960 Bizkaia, Spain
| | - Araly Chacón-Uribe
- Department of Otorhinolaryngology, Hospital Universitario Fundación Jiménez Diaz, 28042 Madrid, Spain
| | - Guillermo Plaza
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
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10
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Conforti S, Licchetta G, Reda M, Astaneh A, Pogliani L, Fieschi S, Rinaldo A, Torre M. Management of COVID-19-related post-intubation tracheal stenosis. Front Surg 2023; 10:1129803. [PMID: 36969759 PMCID: PMC10034358 DOI: 10.3389/fsurg.2023.1129803] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/01/2023] [Indexed: 03/11/2023] Open
Abstract
Introduction The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic has affected Italy since the beginning of 2020. Endotracheal intubation, prolonged mechanical ventilation, and tracheostomy are frequently required in patients with severe COVID-19. Tracheal stenosis is a potentially severe condition that can occur as a complication after intubation. The aim of this study was to evaluate the utility and safety of endoscopic and surgical techniques in the treatment of tracheal stenosis related to COVID-19. Materials and Methods Between June 2020 and May 2022, consecutive patients with tracheal stenosis who were admitted to our surgical department were considered eligible for participation in the study. Results A total of 13 patients were included in the study. They consisted of nine women (69%) and four men (31%) with a median age of 57.2 years. We included seven patients with post-tracheostomy tracheal stenosis. Bronchoscopy was performed to identify the type, location, and severity of the stenosis. All patients underwent bronchoscopic dilation and surveillance bronchoscopy at 7 and 30 days after the procedure. We repeated endoscopic treatment in eight patients. Three patients underwent tracheal resection anastomosis. Final follow-up bronchoscopy demonstrated no residual stenosis. Conclusions The incidence of and risk factors associated with tracheal stenosis in critically ill patients with COVID-19 are currently unknown. Our experience confirms the efficacy and safety of endoscopic management followed by surgical procedures in cases of relapsed tracheal stenosis.
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Affiliation(s)
- Serena Conforti
- Department of Thoracic Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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11
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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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12
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Mukai N, Okada M, Konishi S, Okita M, Ogawa S, Nishikawa K, Annen S, Ohshita M, Matsumoto H, Murata S, Harima Y, Kikuchi S, Aibara S, Sei H, Aoishi K, Asayama R, Sato E, Takagi T, Tanaka-Nishikubo K, Teraoka M, Hato N, Takeba J, Sato N. Cricotracheostomy for patients with severe COVID-19: A case control study. Front Surg 2023; 10:1082699. [PMID: 36733889 PMCID: PMC9888534 DOI: 10.3389/fsurg.2023.1082699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Background Tracheostomy is an important procedure for the treatment of severe coronavirus disease-2019 (COVID-19). Older age and obesity have been reported to be associated with the risk of severe COVID-19 and prolonged intubation, and anticoagulants are often administered in patients with severe COVID-19; these factors are also related to a higher risk of tracheostomy. Cricotracheostomy, a modified procedure for opening the airway through intentional partial cricoid cartilage resection, was recently reported to be useful in cases with low-lying larynx, obesity, stiff neck, and bleeding tendency. Here, we investigated the usefulness and safety of cricotracheostomy for severe COVID-19 patients. Materials and methods Fifteen patients with severe COVID-19 who underwent cricotracheostomy between January 2021 and April 2022 with a follow-up period of ≥ 14 days were included in this study. Forty patients with respiratory failure not related to COVID-19 who underwent traditional tracheostomy between January 2015 and April 2022 comprised the control group. Data were collected from medical records and comprised age, sex, body mass index, interval from intubation to tracheostomy, use of anticoagulants, complications of tracheostomy, and decannulation. Results Age, sex, and days from intubation to tracheostomy were not significantly different between the COVID-19/cricotracheostomy and control/traditional tracheostomy groups. Body mass index was significantly higher in the COVID-19 group than that in the control group (P = 0.02). The rate of use of anticoagulants was significantly higher in the COVID-19 group compared with the control group (P < 0.01). Peri-operative bleeding, subcutaneous emphysema, and stomal infection rates were not different between the groups, while stomal granulation was significantly less in the COVID-19 group (P = 0.04). Conclusions These results suggest that cricotracheostomy is a safe procedure in patients with severe COVID-19.
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Affiliation(s)
- Naoki Mukai
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan,Correspondence: Masahiro Okada
| | - Saki Konishi
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Mitsuo Okita
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Siro Ogawa
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kosuke Nishikawa
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan,Department of Bone and Joint Surgery, Ehime University School of Medicine, Toon, Japan
| | - Suguru Annen
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Muneaki Ohshita
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hironori Matsumoto
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Satoru Murata
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yutaka Harima
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Satoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shiori Aibara
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hirofumi Sei
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kunihide Aoishi
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Rie Asayama
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Eriko Sato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Taro Takagi
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kaori Tanaka-Nishikubo
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masato Teraoka
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jun Takeba
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Norio Sato
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
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13
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Orlandi R, Raveglia F, Calderoni M, Cassina EM, Cioffi U, Guttadauro A, Libretti L, Pirondini E, Rimessi A, Tuoro A, Passera E. Management of COVID-19 related tracheal stenosis: The state of art. Front Surg 2023; 10:1118477. [PMID: 36891547 PMCID: PMC9986964 DOI: 10.3389/fsurg.2023.1118477] [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] [Received: 12/07/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
Tracheal stenosis (TS) is a debilitating disease promoted by pathologic narrowing of the trachea. The acute respiratory distress syndrome caused by COVID-19 has been demonstrated to trigger enhanced inflammatory response and to require prolonged invasive mechanical ventilation as well as high frequency of re-intubation or emergency intubation, thus increasing the rate and complexity of TS. The standard-of-care of COVID-19-related tracheal complications has yet to be established and this is a matter of concern. This review aims at collecting latest evidence on this disease, providing an exhaustive overview on its distinctive features and open issues, and investigating different diagnostic and therapeutic strategies to handle COVID-19-induced TS, focusing on endoscopic versus open surgical approach. The former encompasses bronchoscopic procedures: electrocautery or laser-assisted incisions, ballooning dilation, submucosal steroid injection, endoluminal stenting. The latter consists of tracheal resection with end-to-end anastomosis. As a rule, traditionally, the endoscopic management is restricted to short, low-grade, and simple TS, whereas the open techniques are employed in long, high-grade, and complex TS. However, the critical conditions or extreme comorbidities of several COVID-19 patients, as well as the marked inflammation in tracheal mucosa, have led some authors to apply endoscopic management also in complex TS, recording acceptable results. Although severe COVID-19 seems to be an issue of the past, its long-term complications are still unknown and considering the increased rate and complexity of TS in these patients, we strongly believe that it is worth to focus on it, attempting to find the best management strategy for COVID-19-related TS.
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Affiliation(s)
- Riccardo Orlandi
- Department of Thoracic Surgery, University of Milan, Milan, Italy
| | - Federico Raveglia
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Matteo Calderoni
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, School of Medicine and Surgery, Università degli Studi di Milano Bicocca, Monza, Italy
| | - Lidia Libretti
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Emanuele Pirondini
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Arianna Rimessi
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Antonio Tuoro
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Eliseo Passera
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
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14
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Muacevic A, Adler JR, P SR, MS B, Nanjunda Rao RB. Achieving Successful Extubation and Cost-Effective Recovery Following Anesthetic Airway Management in Supracarinal Tracheal Reconstruction Surgeries: A Retrospective Analysis. Cureus 2023; 15:e34225. [PMID: 36852367 PMCID: PMC9960377 DOI: 10.7759/cureus.34225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction From an anesthesiologist's perspective, perioperative concerns related to supracarinal tracheal reconstruction surgery include having uninterrupted smooth ventilation without any laryngeal edema, glottic dysfunction, and airway leak. Surgical concerns comprise various kinds of anastomotic dissections, fistulas to innominate arteries, and the esophagus. The most serious complication following tracheal surgery is anastomotic separation, which might manifest modestly as stridor, respiratory distress, and extremis. To avoid dire repercussions, prompt management and securing the airway are necessary. Against this background, we wanted to highlight the importance of early extubation and discharge of supracarinal tracheal reconstruction patients from hospitals without any postoperative complications and with the least expenses possible, since most of these patients have already undergone postintubation tracheal stenosis and prolonged intensive care unit stay, and have experienced significant financial burden incurring from preceding events. Methodology Medical records of all patients admitted for tracheal reconstruction during the period from March 2019 to April 2022 (four years) were reviewed to collect patient demographic details, surgical descriptions, anesthesia data, records of pre-anesthetic evaluations, and postoperative details up until the hospital discharge. Results The most common reason for tracheal stenosis among our patients was post-intubation tracheal stenosis (PITS), which was seen in 8/13 patients (61.53%); 4/13 patients (30.76%) had stridor at rest and underwent emergency tracheostomy preoperatively immediately following admission to the hospital. The stenosis was situated at a median distance of 3 cm [interquartile range (IQR): 0.5-7] from the true vocal cords or 7 cm (IQR: 3-9) from the carina. The median length of tracheal resection was 2 cm (IQR: 1-4). We observed that the mode of induction for airway management was tracheostomy tube in four patients (with 90% tracheal stenosis), placement of laryngeal mask airway (LMA) with spontaneous ventilation in four patients (with 75% tracheal stenosis), and small-size (#5-7.5 sizes) endotracheal tube (ETT) placement in five patients (with less than 75% tracheal stenosis). The postoperative complication noted was bleeding from the operative site in 1/13 patients (7.6%); a 0% mortality rate was noted during the hospital stay and up until six months post-discharge. We noted that the median duration of postoperative hospitalization was five days (IQR: 2-15), and the total cost incurred by each patient was less than INR 85,000 (USD 1,000). Conclusion Our analysis revealed that all our patients were extubated in the operative room and shifted to the ward. In the "open airway phase", standard distal tracheal intubation and cross-field ventilation techniques, and tracheal suturing were facilitated by the apnoea-ventilation-apnoea technique. Both the techniques along with the emergency tracheostomies done in severe tracheal obstruction preoperatively and intraoperative anesthesia management with the insertion of LMA Supreme, maintained with spontaneous breathing techniques, offered potential advantages in the management of supracarinal tracheal reconstruction surgeries. The multidisciplinary teamwork along with close communication and good rapport with the surgical team was found to be the key factor in the fast-track extubation and recovery of these patients.
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