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Yang M, Li H, Zhou Y, Li H, Wei H, Cheng Q. Airway collapse hinders recovery in bronchoscopy therapy for postintubation tracheal stenosis patients. Eur Arch Otorhinolaryngol 2024; 281:3061-3069. [PMID: 38582815 PMCID: PMC11065913 DOI: 10.1007/s00405-024-08602-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/05/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Expiratory central airway collapse (ECAC) following postintubation airway stenosis (PITS) is a rare phenomenon. The impact of airway malacia and collapse on the prognosis and the success rate of bronchoscopic interventional therapy in patients with PITS had been inadequately investigated. OBJECTIVE The aim of this research was to assess the influence of airway malacia and collapse on the efficacy of bronchoscopic interventional therapy in patients with PITS. DESIGN This retrospective analysis examined the medical documentation of individuals diagnosed with PITS who underwent bronchoscopic intervention at the tertiary interventional pulmonology center of Emergency General Hospital from 2014 to 2021. MAIN OUTCOME MEASURES Data pertaining to preoperative, perioperative, and postoperative stages were documented and subjected to analysis. RESULTS The patients in malacia and collapse group (MC group) exhibited a higher frequency of perioperative complications, including intraoperative hypoxemia, need for reoperation within 24 h, and postoperative intensive care unit admission rate (P < 0.05, respectively). Meanwhile, patients in group MC demonstrated significantly worse postoperative scores (higher mMRC score and lower KPS score) compared to those in pure stenosis group (P < 0.05, respectively), along with higher degrees of stenosis after treatment and a lower success rate of bronchoscopic intervention therapy cured (P < 0.05, respectively). Pearson analysis results showed that these terms were all significantly correlated with the occurrence of airway malacia and collapse in the airway (P < 0.05, respectively). CONCLUSION The presence of malacia or collapse in patients with PITS was associated with increased perioperative complications following bronchoscopic interventional therapy, and significantly reduced the long-term cure rate compared to patients with pure tracheal stenosis. Trial registration Chinese Clinical Trial Registry on 06/12/2021. REGISTRATION NUMBER ChiCTR2100053991.
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Affiliation(s)
- Mingyuan Yang
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China
| | - Hong Li
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China
| | - Yunzhi Zhou
- Department of Pulmonary and Critical Care Medicine, Emergency General Hospital, Beijing, China
| | - Hao Li
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China
| | - Huafeng Wei
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Qinghao Cheng
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China.
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Hosna A, Haseeb Ul Rasool M, Noff NC, Makhoul K, Miller D, Umar Z, Ghallab M, Hasan R, Ashfaq S, Parikh A, Lopez R. Cryotherapy for the Treatment of Tracheal Stenosis: A Systematic Review. Cureus 2023; 15:e41012. [PMID: 37519508 PMCID: PMC10372464 DOI: 10.7759/cureus.41012] [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: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Tracheal stenosis (TS) is an iatrogenic sequela after intubation or tracheostomy that is increasing despite technological improvement and skilled respiratory care in the ICU. According to the studies, the rate of TS varies from 10 to 22%, but only 1-2% of these stenoses are severe and present with inspiratory dyspnea that does not respond to medical management. Bronchoscopy is considered the most appropriate diagnostic test, and laser surgery and tracheobronchial stenting are the most commonly performed procedures for tracheal stenosis. However, alternative treatment options, including cryotherapy for inoperable patients, have yet to be studied widely. As the number of patients requiring ICU admission with mechanical intubation is increasing, it is crucial to acknowledge this complication and consider alternative management options. Here we present a review of the use of cryotherapy for post-intubation tracheal stenosis. Pubmed, Cochrane, and EMBASE databases were inquired for studies performed using the keywords 'airway stricture' OR 'airway obstruction' AND 'post-intubation' OR 'post-extubation' OR 'tracheostomy' AND 'cryotherapy'. After the primary and secondary screening, five studies were included in the analysis. We included 67 patients were included in the analysis, with a mean age of 50.2 (range: 42-55) years. Tracheal stenosis and subglottic stricture were the most common sites of stenosis. Twenty-nine patients were treated with cryotherapy only, while the rest 38 patients had cryotherapy followed by balloon dilation. After the intervention, 48 patients experienced improvement, five experienced no change in the symptoms, 13 patients were asymptomatic before the treatment, and one died. No complication was reported in 65 patients, with only minor complications reported in rest. Although, there is no clear treatment protocol for patients with inoperable tracheal stenosis. Our review demonstrates that cryotherapy for inoperable tracheal stenosis can be an acceptable alternative treatment with significant clinical improvement. Additionally, cryotherapy has fewer adverse effects compared to other treatment options.
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Affiliation(s)
- Asma Hosna
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | | | - Nicole C Noff
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | | | - Daniel Miller
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | - Zaryab Umar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | - Muhammad Ghallab
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals, New York City, USA
| | - Rockyb Hasan
- Internal Medicine, Texas Tech University Health Sciences Center - Amarillo Campus, Lubbock, USA
| | - Salman Ashfaq
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Avish Parikh
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | - Ricardo Lopez
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
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Onorati I, Bonnet N, Radu DM, Freynet O, Guiraudet P, Kambouchner M, Uzunhan Y, Zogheib E, Martinod E. Case Report: Laryngotracheal Post-Intubation/Tracheostomy Stenosis in COVID-19 Patients. Front Surg 2022; 9:874077. [PMID: 35548193 PMCID: PMC9082634 DOI: 10.3389/fsurg.2022.874077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The novel Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has spread rapidly to become a major global public health emergency since March 2020. Laryngotracheal stenosis (LTS) has been observed more frequently since the onset of the COVID-19 pandemic. Methods All patients referred to our 24/7 Airway Diseases Center for laryngotracheal post-intubation/tracheostomy stenosis from May 2020 to May 2021were evaluated retrospectively. Patient data on comorbidities, diagnosis, type of procedures, lengths of ICU stay and invasive mechanical ventilation, medical treatment, and the severity of illness were recorded. Results This case series included nine patients (five women and four men), with a mean age of 52.9 years, most with a BMI >30, all with a severe illness revealed by the Simplified Acute Physiology Score (SAPS) II >31. From May 2020 to May 2021, 21 procedures were performed on seven patients, consisting of bronchoscopic rigid interventions, T-tube Montgomery tracheostomy, and one cricotracheal resection with end-to-end anastomosis. Histologic examination of tracheal biopsies showed an inflammatory state of the airway mucosa. Two patients only had medical therapy. Discussion and Conclusions Pneumonia caused by SARSCoV-2 can lead to severe acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. The time of intubation, the drugs used, the prone position, comorbidities (diabetes, obesity), and the inflammatory state of the upper airways linked to the viral infection, predispose to an increased tendency to stenosis and its recurrence. A conservative approach with medical and endoscopic treatment should be preferred in case of persistence of local airways inflammation. Further studies with a larger sample of patients will help to a better understanding of the disease, reduce the prevalence, and improve its treatment.
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Affiliation(s)
- Ilaria Onorati
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
- *Correspondence: Ilaria Onorati
| | - Nicolas Bonnet
- Department of Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Dana Mihaela Radu
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Olivia Freynet
- Department of Pulmonology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Patrice Guiraudet
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Yurdagul Uzunhan
- Department of Pulmonology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Elie Zogheib
- Department of Anesthesiology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Emmanuel Martinod
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
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Flexible Bronchoscopy Combined with Rigid Bronchoscopy for Treatment of Scarring in the Bronchus Caused by a Foreign Body. Case Rep Med 2019; 2019:4616298. [PMID: 31316565 PMCID: PMC6604489 DOI: 10.1155/2019/4616298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/16/2019] [Accepted: 05/15/2019] [Indexed: 12/17/2022] Open
Abstract
Foreign body (FB) aspiration into the tracheobronchial tree is an emergency in the pediatric department, particularly in children aged <3 years. FB granulation tissue is commonly found in children with FB aspiration. However, scarring in the bronchus caused by a FB is rare. We herein report a case involving aspiration of a plastic whistle toy with scarring in the bronchus. The scar tissue was successfully removed by interventional bronchoscopy combined with a flexible electrosurgery probe and carbon dioxide cryotherapy.
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Post-intubation tracheobronchomalacia in a young adult: A rare case report. Respir Med Case Rep 2018; 23:66-67. [PMID: 29487785 PMCID: PMC5805845 DOI: 10.1016/j.rmcr.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/09/2017] [Accepted: 12/12/2017] [Indexed: 11/24/2022] Open
Abstract
Tracheobronchomalacia (TBM) is characterized by weakness of cartilaginous supporting structures of tracheal and bronchial walls, resulting in central airway obstruction. It is a rare condition that can occur after prolonged intubation. Here, we report a 26-year-old, alcoholic male who had TBM, mild subglottic, and severe tracheal stenosis following 2 weeks of intubation. Subglottic and tracheal stenosis can occur after extubation but TBM is uncommon. The exact mechanism is still unknown but post-intubation TBM is a life-threatening condition with high morbidity and mortality if left untreated. Early detection and timely management can improve the outcome of patients.
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Ulusan A, Sanli M, Isik AF, Celik İA, Tuncozgur B, Elbeyli L. Surgical treatment of postintubation tracheal stenosis: A retrospective 22-patient series from a single center. Asian J Surg 2017; 41:356-362. [PMID: 28412038 DOI: 10.1016/j.asjsur.2017.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/22/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE We aimed to present cases of postintubation tracheal stenosis (PITS), all due to long-term intubation and treated surgically in a university hospital, and to discuss them in light of the literature. METHODS In this retrospective study, 22 patients who were treated with tracheal resection and reconstruction due to PITS were included. Demographics, intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. RESULTS The mean intubation duration was 16.95 days with a median of 15.00 days. Collar incision was applied in 19 cases (86.4%); in two cases (9.1%) a median sternotomy incision was used; and in the remaining case (4.5%), a right thoracotomy incision was made. The mean tracheal stenosis length was 2.14 cm (mean excision length, 2.5 cm). In 17 cases (77.3%), the anterior walls were supported with vicryl (polyglactin) suture one by one. No postoperative complications were observed in 12 cases (54.5%). No recurrence developed during the long-term follow-up of 15 of the 22 patients (68.2%). Two patients (9.1%) died in the early stages after surgery, and five patients (22.7%) had a stent inserted due to restenosis. CONCLUSION Tracheal resection and end-to-end anastomosis are the most efficient techniques in cases without medical contraindications, despite emerging stent or endoscopic procedures. Endoscopic interventions can be suggested as an alternative to surgery in patients for whom surgery cannot be performed or who develop recurrence.
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Affiliation(s)
- Ahmet Ulusan
- Department of Thoracic Surgery, Hitit University Corum Education and Research Hospital, Corum, Turkey.
| | - Maruf Sanli
- Department of Thoracic Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Ahmet Feridun Isik
- Department of Thoracic Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - İlknur Aytekin Celik
- Thoracic Surgery Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Bulent Tuncozgur
- Department of Thoracic Surgery, Ankara Guven Hospital, Ankara, Turkey
| | - Levent Elbeyli
- Department of Thoracic Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
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