Estimating the population incidence of adult post‐intubation laryngotracheal stenosis

Nouraei, S.A.R.; Ma, Eluwa; Patel, Anil; Howard, David; Sandhu, Guri

doi:10.1111/j.1749-4486.2007.01484.x

Cited by 131 publications

(87 citation statements)

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“…Tracheal stenosis is the most common late complication following prolonged intubation and tracheostomy with 10-22 % develop post intubation and post tracheostomy stenosis [11]. Among them only 1-2 % develop symptomatic and severe stenosis which require intervention [12]. Prolonged intubation is still the commonest cause of laryngotracheal stenosis in our practice.…”

Section: Discussionmentioning

confidence: 99%

Use of Conchal Cartilages for Laryngotracheal Stenosis: Experiences at a Tertiary Care Hospital of Eastern India

Swain

Singh

Samal

et al. 2016

Indian J Otolaryngol Head Neck Surg

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To describe the experience of anterior cricotracheal split with insertion of conchal cartilage graft in the treatment of subglottic and tracheal stenosis at a tertiary care hospital of eastern India. Six patients were included in the study, in the age group of 20-48 years. Out of which five patients were successfully decannulated after 3 months of laryngotracheal reconstruction with help of conchal cartilage. One case was undergone resection anastomosis after failure of the above technique. Successful restoration of the airway with decannulation in five cases and failure in one case. The subglottic and upper tracheal stenosis are successfully treated with anterior cricotracheal split and augmentation of the airway with conchal cartilage. It is a new technique of using conchal cartilage in the literature of laryngotracheal reconstruction.

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Section: Discussionmentioning

confidence: 99%

Use of Conchal Cartilages for Laryngotracheal Stenosis: Experiences at a Tertiary Care Hospital of Eastern India

Swain

Singh

Samal

et al. 2016

Indian J Otolaryngol Head Neck Surg

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“…TS is the commonest late complication of prolonged intubation and tracheostomy with 10-22 % develop PI and PT stenosis [2]. Only 1-2 % finally develop symptomatic and severe stenosis needing intervention [3]. The stenotic process begins with trauma and ulceration of tracheal mucosa with superimposed local infection leading to perichondritis of tracheal cartilage followed by increased fibroblastic activity leading to circumferential scarring and airway obstruction.…”

Section: Discussionmentioning

confidence: 99%

Tracheal Stenosis: Our Experience at a Tertiary Care Centre in India with Special Regard to Cause and Management

Nair

Mohan

Mandal

et al. 2013

Indian J Otolaryngol Head Neck Surg

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Tracheal stenosis (TS), a challenging problem, is a known complication of prolonged intubation and tracheostomy. The management involves a multidisciplinary approach with multiple complex procedures. In this study we discuss our experience with severe TS with regards to patient characteristics, cause and management. A retrospective analysis of 20 patients of severe TS treated at a tertiary care centre was evaluated. Inclusion criteria were all patients with severe TS who required surgical intervention. Exclusion criteria were patients with associated laryngeal stenosis and TS due to cancer. Demographic data was recorded and findings relating to aetiology, characteristics of stenosis and the various aspects of therapeutic procedures performed are discussed with review of literature. Descriptive analysis of data were performed SPSS 18. Results of the 20 patients, 17 patients (85 %) developed TS post tracheostomy, or post intubation and subsequent tracheostomy. 13 Patients (65 %) had true stenosis of which 7 patients (35 %) had simple web or circumferential fibrosis and 6 patients (30 %) had complex stenosis. Seven patients (35 %) had granulations causing severe TS which were mostly suprastomal (5 patients), stomal (5 patients) and combined stomal and suprastomal (3 patients). The average length of stenosis was 3.57 cm (0.5-8 cm). Montgomery t tube insertion was a common procedure in 18 patients (90 %) pre or post intervention. Each patient underwent an average of 3.4 procedures during their course of treatment which included rigid bronchoscopy and mechanical debulking, Nd YAG laser, KTP laser, balloon dilatation and use of stents. Among the 7 patients with granulations 100 % successful decanulation was noted with endoscopic management whereas in 13 patients with true stenosis, 10 patients (76.9 %) required open surgical management (8 tracheal resection and anastomosis and 2 tracheoplasty) with 80 % successful decanulation, 2 patients (15.4 %) were treated with endoscopy with 100 % successful decanulation and 1 patient (7.7 %) was a non surgical candidate on stent. Of the total 20 patients with severe TS in this series, 17 (85 %) of patients who were decanulated, asymptomatic on routine daily activities with normal FFB were considered cured. TS is a challenging condition requiring a highly skilled multidisciplinary team for adequate management. Prolonged intubation and tracheostomy are the common causes leading to tracheal stenosis. Simple tracheal stenosis is easier to manage than a complex stenosis which usually requires an open surgical procedure for successful management. Presence of conditions like tracheoesophageal fistula and long segment tracheomalacia are poor factors for successful management. In our cases successful decanulation was possible in 85 % of the patients following a systematic multidisciplinary approach.

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“…6 Stenosis can occur anywhere from the level of the ETT tip up to the glottic and subglottic area but the most common sites of stenosis are where the ETT cuff has been in contact with the tracheal wall and at the tracheal stoma site following a tracheostomy. 7 As a result, tracheal stenosis occurs most commonly following the two types of airway intubation: endotracheal intubation and tracheostomy. 8 The postulated causative factor for stenosis is loss or reduction of regional blood flow due to the pressure emitted through the cuff on the tracheal wall.…”

Section: Discussionmentioning

confidence: 99%

First-line tracheal resection and primary anastomosis for postintubation tracheal stenosis

Elsayed

Mostafa

Soliman

et al. 2016

annals

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INTRODUCTION Tracheal stenosis following intubation is the most common indication for tracheal resection and reconstruction. Endoscopic dilation is almost always associated with recurrence. This study investigated first-line surgical resection and anastomosis performed in fit patients presenting with postintubation tracheal stenosis. METHODS Between February 2011 and November 2014, a prospective study was performed involving patients who underwent first-line tracheal resection and primary anastomosis after presenting with postintubation tracheal stenosis. RESULTS A total of 30 patients (20 male) were operated on. The median age was 23.5 years (range: 13-77 years). Seventeen patients (56.7%) had had previous endoscopic tracheal dilation, four (13.3%) had had tracheal stents inserted prior to surgery and one (3.3%) had undergone previous tracheal resection. Nineteen patients (63.3%) had had a tracheostomy. Eight patients (26.7%) had had no previous tracheal interventions. The median time of intubation in those developing tracheal stenosis was 20.5 days (range: 0-45 days). The median length of hospital stay was 10.5 days (range: 7-21 days). The success rate for anastomoses was 96.7% (29/30). One patient needed a permanent tracheostomy. The in-hospital mortality rate was 3.3%: 1 patient died from a chest infection 21 days after surgery. There was no mortality or morbidity in the group undergoing first-line surgery for de novo tracheal lesions. CONCLUSIONS First-line tracheal resection with primary anastomosis is a safe option for the treatment of tracheal stenosis following intubation and obviates the need for repeated dilations. Endoscopic dilation should be reserved for those patients with significant co-morbidities or as a temporary measure in non-equipped centres.

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Estimating the population incidence of adult post‐intubation laryngotracheal stenosis

Cited by 131 publications

References 4 publications

Use of Conchal Cartilages for Laryngotracheal Stenosis: Experiences at a Tertiary Care Hospital of Eastern India

Use of Conchal Cartilages for Laryngotracheal Stenosis: Experiences at a Tertiary Care Hospital of Eastern India

Tracheal Stenosis: Our Experience at a Tertiary Care Centre in India with Special Regard to Cause and Management

First-line tracheal resection and primary anastomosis for postintubation tracheal stenosis

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