Clinical significance of differentiating post‐intubation and post‐tracheostomy tracheal stenosis

Abstract

There were significant differences between PITS and PTTS in terms of patient and stenosis characteristics, treatment modalities and clinical outcomes. Therefore, PITS and PTTS should be considered two different entities.

Benign Central Airway Obstruction

“…PITS and PTTS are estimated to affect 4.9 patients per million per year. 45 Stenoses can generally be divided into two categories: simple and complex. Simple refers to weblike, concentric, membranous stenoses that are <1 cm in length and do not involve damage to the cartilage.…”

“…46 A retrospective study of 117 patients with PITS and 81 with PTTS demonstrated that patients with PTTS typically had more complex stenoses, lower success rates with interventional procedures, and lower rates of airway prosthesis removal as compared to those with PITS. 45 Treatment of simple PITS and PTTS has predominantly consisted of bronchoscopic intervention utilizing intermittent dilations often coupled with debridement of granulation tissue via thermal energy modes or cryotherapy. A mucosal sparing approach using thermal energy, such as the Nd:YAG laser, for photodissection prior to gentle dilation can prove effective in preventing recurrence in certain patients with tracheal stenosis, particularly those with shorter stenoses without malacia.…”

Clinical implications of differentiating between types of post-tracheostomy tracheal stenosis

“…Of these patients, 99 were identified to have tracheal stenosis after tracheostomy. Some patients who were reported in a previous study were re-evaluated in terms of clinical outcomes for extension of follow-up duration (10). Patients with PTTS were classified into two groups, "subglottic or stoma" and "cuff or tip," based on clinical, bronchoscopic, and radiological findings, which were thoroughly reviewed by three of the authors (B Shin, K Kim, and BH Jeong).…”

“…Interventional bronchoscopy was performed according to standard techniques after induction of general anesthesia and intubation with a rigid bronchoscope tube (Bryan Co., Woburn, MA, USA) (14,15). Depending on the subtype of tracheal stenosis and the general health status of the patient, individualized intervention techniques were designed, such as mechanical dilation, balloon dilation, laser therapy, and insertion of a silicone stent, as previously reported (10,(16)(17)(18). When localized dense fibrosis was observed, a laser was used to cut the fibrotic band.…”

“…Demographic data, stenosis characteristics, and clinical outcomes were obtained as in our previous study (10). In short, poor performance was defined as an Eastern Cooperative Oncology Group (ECOG) grade ≥3, which means the patient is confined to bed or a chair more than 50% of their waking hours (26).…”