Development of a survival animal model for subglottic stenosis

Schweiger, Cláudia; Hart, Catherine K.; Tabangin, Meredith E.; Cohen, Aliza P.; Roetting, Nicholas J; DeMarcantonio, Michael; Becker, Elise; Ward, Jonette A.; Alarcón, Alessandro de

doi:10.1002/lary.27441

Cited by 13 publications

(20 citation statements)

References 13 publications

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“…The result showed that all the 37 patients underwent T-tube placement the first time in treating airway stenosis and the treatment period was at least 10 months, with an extubating rate of 83.7%, demonstrating the effectiveness of T-tube placement in treating cervical airway stenosis [13]. Furthermore, an experiment induced subglottic stenosis in animal models, and its results showed that endoscopic intervention treatment for subglottic stenosis is well instructive [14], which is of guiding significance for future intervention treatment with endoscopy for airway stenosis. Our study was targeted to patients with Cotton-Myer IV subglottic airway stenosis and retrospectively explored the effectiveness and safety of T-tube placement in treating subglottic airway stenosis with a rigid bronchoscope after bi-level airway recanalization.…”

Section: Discussionmentioning

confidence: 99%

Application of Montgomery T-Tube Placement in Treating Cotton-Myer IV Subglottic Airway Atresia after Bi-Level Airway Recanalization

Yao

et al. 2021

Computational and Mathematical Methods in Medicine

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Objective. The purpose of this study is to explore the effectiveness and safety of Montgomery T-tube placement in treating Cotton-Myer IV subglottic airway atresia after bi-level airway recanalization. Methods. This study is a retrospective study. 11 patients who were treated for IV subglottic airway atresia between January 2017 and January 2019 in the Second Affiliated Hospital of Jiaxing University were involved in this study. The 11 patients all had undergone tracheotomies at our hospital, and they were transferred to the Department of Pulmonary and Critical Care Medicine for Montgomery T-tube placement after bi-level airway recanalization when their subglottic airway was atretic. Patients were observed for their clinical manifestations after placement. The effectiveness of T-tube placement after bi-level airway recanalization was assessed. The incidence of short-term and long-term complications after surgery was assessed. Patients were followed up for 3 to 24 months for evaluating their airway recovery. Results. T-tubes were successfully placed in 11 patients. The atretic airways of all patients were recanalized after treatment. Eight patients got restoration of vocal ability, and 3 patients could only say simple words. None of the patients needed assisted oxygen inhalation. The SpO2 average level was increased from 95 ± 2 % before treatment to 97 ± 3 % after treatment. Patients had significant relief of cough or sputum, and they had less difficulty in dyspnea. All short- or long-term complications were self-relieved or controlled without further malignant progression after treatment by doctors. The average postoperative extubating time was ( 14.86 ± 3.62 ) months. Conclusion. The application of Montgomery T-tube placement in treating Cotton-Myer IV subglottic airway atresia after bi-level airway recanalization is well effective and safe for patients, and it can be promoted in clinical treatment.

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Section: Discussionmentioning

confidence: 99%

Application of Montgomery T-Tube Placement in Treating Cotton-Myer IV Subglottic Airway Atresia after Bi-Level Airway Recanalization

Yao

et al. 2021

Computational and Mathematical Methods in Medicine

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“…As previously described in the literature, the brush was trimmed to maintain 10 mm of nylon bristles at the distal tip of the wire and rotated an average of 40 times along the subglottic mucosa to create the epithelial injury. 19 To minimize collateral trauma upon insertion, a modified Seldinger technique was employed by telescoping a 3.5-mm uncuffed ETT over the nylon brush. Though the technique improved unwanted mucosal trauma, particularly in the glottis, we found the method cumbersome to perform under direct visualization with endoscopy, at least for a 2-handed, 1-surgeon technique.…”

Section: Methodsmentioning

confidence: 99%

“…Endoscopic methods for injury, including endotracheal intubation and cautery, are widely described, with success in producing low to moderate stenosis (grade 1 or 2). 19 These current models, however, remain limited by high mortality and morbidity, large variability in the degree of stenosis, and subjectivity of the endoscopic stenosis grading methods. [20][21][22][23] A critical preclinical approach in understanding the biology of SGS and translating investigative technologies from the bench to the bedside is the use of these rabbit models.…”

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confidence: 99%

Subglottic Stenosis: Development of a Clinically Relevant Endoscopic Animal Model

Mady

Criado

Park

et al. 2020

Otolaryngol.--head neck surg.

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Objective Develop a clinically relevant and reproducible endoscopic animal model for subglottic stenosis amenable to testing of minimally invasive therapeutic modalities. Study Design Cohort study. Setting Division of Laboratory Animals Research, University of Pittsburgh. Subjects and Methods Subglottic stenosis was induced endoscopically via microsuspension laryngoscopy in 26 New Zealand white rabbits. A trimmed polypropylene brush connected to a novel electronic stenosis induction apparatus was used to create circumferential trauma to the subglottis. By using open source image analysis software, the cross-sectional areas of the stenotic and native airways were compared to calculate the percentage of stenosis and the Myer-Cotton classification grade. Results Of the 26 rabbits, 24 (92%) exhibited stenosis after the first attempt. The mean percentage of airway stenosis was 57% (range, 34%-85%; SD, 15%). Five rabbits (19.2%) died on the day of stenosis induction from procedural complications. Of the 21 rabbits, 2 demonstrated no stenosis 7 days after initial injury and so underwent reinduction of airway injury, upon which they developed stenosis. Overall, 14 of the 21 rabbits (67%) exhibited moderate to severe stenosis (grade 2 or 3). Conclusion The stenosis induction apparatus reliably induced stenosis with a low mortality rate as compared with that of other methods in the literature. The device could be improved to generate a predetermined potentially reproducible grade of stenosis as desired by the operator. This method sets the stage for a clinically relevant and reproducible subglottic stenosis disease model that is amenable to testing of minimally invasive treatment modalities.

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“…Subglottic stenosis induction was carried out following a previously described protocol . Bugbee monopolar cautery was inserted under endoscopic visualization and used to injure 75% of the circumference of the posterior subglottic area with 7 watts of power for approximately 5 seconds.…”

Section: Methodsmentioning

confidence: 99%

Impact of Balloon Diameter on Dilation Outcomes in a Model of Rabbit Subglottic Stenosis

et al. 2018

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Objective To determine the appropriate balloon size for dilation using a previously described reproducible survival animal model of subglottic stenosis. Study Design Prospective animal study. Methods We conducted a prospective study including 16 New Zealand White rabbits. The airway of each animal was sized with an endotracheal tube (ETT), and subglottic stenosis (SGS) was endoscopically induced using Bugbee electrocautery to 75% of the circumference of the subglottis, followed by 4‐hour intubation. Two weeks postoperatively, the rabbits' airways were sized and then dilated using a 6‐, 7‐, 8‐, or 9‐mm balloon, with four animals in each experimental group. Following dilation, animals were again sized and subsequently euthanized. The cricoid lumen was measured microscopically in each animal. Results Prior to inducing stenosis, all animals were sized with a 3.5 ETT. After inducing injury but prior to dilation, airways showed grade 2 SGS that sized with a 2.5 ETT with no leak. Postdilation, animals dilated with 6‐ or 7‐mm balloons (n = 8) sized with a 3.0 ETT, and animals dilated with an 8‐ or 9‐mm balloon (n = 8) sized with a 3.5 ETT. Postdilation median cricoid lumen measurements were 12.5 mm2 (6‐mm balloon), 13.92 mm2 (7 mm), 16.83 mm2 (8 mm), and 17.15 mm2 (9 mm); two cricoid fractures occurred in the 9‐mm group. Conclusion The postdilation cricoid lumen diameter increased with increased balloon size, and the use of an 8‐mm balloon achieved the largest cricoid lumen diameter without causing fracture. Further research is necessary to determine the ideal duration of dilation and optimal intervals between dilations. Level of Evidence NA Laryngoscope, 129:2409–2413, 2019

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Development of a survival animal model for subglottic stenosis

Abstract: NA. Laryngoscope, 2018.

Cited by 13 publications

References 13 publications

Application of Montgomery T-Tube Placement in Treating Cotton-Myer IV Subglottic Airway Atresia after Bi-Level Airway Recanalization

Application of Montgomery T-Tube Placement in Treating Cotton-Myer IV Subglottic Airway Atresia after Bi-Level Airway Recanalization

Subglottic Stenosis: Development of a Clinically Relevant Endoscopic Animal Model

Impact of Balloon Diameter on Dilation Outcomes in a Model of Rabbit Subglottic Stenosis

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