Laryngotracheal obstruction complicating tracheostomy or endotracheal intubation with assisted respiration. A critical review.

Harley, H. R. S.

doi:10.1136/thx.26.5.493

Cited by 75 publications

(39 citation statements)

References 137 publications

(367 reference statements)

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“…PATHOGENESIS Ulcerative tracheo-oesophageal fistula caused by tracheostomy and assisted ventilation occurs at the site of the cuff or tip of the tracheostomy tube, usually the former (vide infra), and their aetiology is the same as that of tracheal stenosis occurring at these sites. The pathology and pathogenesis of the tracheal damage, together with its prevention, have been discussed comprehensively elsewhere (Harley, 1971) and the reader is referred to that article for full details and bibliography.…”

mentioning

confidence: 99%

“…The importance of infection cannot be over-emphasized (Harley, 1971), and has been stressed in the context of tracheo-oesophageal fistula by a number of workers (Atherstone and Ryder, 1967;Toty, Hertzog, Diane, and Aboudi, 1967;Nicolas et al, 1967;St0ren and Vasli, 1968). Other factors such as chemical irritation, hypotension, and antiinflammatory agents, such as steroids or phenylbutazone (Nicolas et al, 1967;Hedden, Ersoz, and Safar, 1969), may further add to the damage caused by pressure-infective necrosis. If ulceration extends through the whole thickness of the membraneous wall of the trachea before a fibrotic reaction, leading to stenosis, has had time to occur then a tracheo-oesophageal fistula may result (Harley, 1971).…”

mentioning

confidence: 99%

“…Other factors such as chemical irritation, hypotension, and antiinflammatory agents, such as steroids or phenylbutazone (Nicolas et al, 1967;Hedden, Ersoz, and Safar, 1969), may further add to the damage caused by pressure-infective necrosis. If ulceration extends through the whole thickness of the membraneous wall of the trachea before a fibrotic reaction, leading to stenosis, has had time to occur then a tracheo-oesophageal fistula may result (Harley, 1971). One of the collected cases (case 39) is illustrated (Fig.…”

mentioning

confidence: 99%

“…The argument that ulceration starts in the trachea, and subsequently extends into the oesophagus, is strongly supported by the fact that ulceration of the trachea, in patients undergoing treatment by IPPV, is not uncommonly confined to the trachea at the site of the inflated cuff or end of the tracheostomy tube, especially the former, and may be so severe as to cause subsequent stenosis (Harley, 1971). When a tracheo-oesophageal fistula develops it does so precisely at these same sites.…”

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confidence: 99%

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Ulcerative tracheo-oesophageal fistula during treatment by tracheostomy and intermittent positive pressure ventilation

Harley

1972

Thorax

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Forty-four collected cases of ulcerative tracheo-oesophageal fistula following tracheostomy and assisted ventilation are reviewed. The condition followed this form of treatment in 05% of cases and must be distinguished from fistulae caused by accident or surgery, and also from laryngotracheal paralysis or dysfunction. The symptomatology, diagnosis, and treatment are discussed in detail. Spontaneous cure of fistulae is rare, and operative closure should be the aim. In one patient in six, surgical closure is excluded by rapid death. When surgery is possible its timing requires critical judgement. Factors requiring assessment are the condition of the patient and of the tissues around the fistula, the necessity to continue assisted ventilation, and the ability to control nutrition, tracheal aspiration from the mouth or stomach, and pulmonary infection. The mortality of those who did not die too rapidly to receive treatment was 61 % without surgery and 45-5% with surgery.

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Ulcerative tracheo-oesophageal fistula during treatment by tracheostomy and intermittent positive pressure ventilation

Harley

1972

Thorax

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“…About 80%> of these stenoses are produced by intubation and long-term artificial respiration [3,7,12,18,22], Although a correlation between du-1 Supported by Arbeitsgemeinschaft zur Förde rung der Pneumologie an der Ruhrlandklinik e.V. ration of artificial respiration and stenosis is not evident, site and cuff pressure are im portant [3], Further, still unknown factors may also exist.…”

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Effects of Surgery on Airway Mechanics in Tracheal Stenosis

Petro¹,

Konietzko²,

Maassen³

1982

Respiration

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12 patients suffering from severe extrathoracic tracheal stenosis mainly caused by long-term artificial ventilation were investigated by comparing their airway mechanics before and after tracheal sleeve resection and during long-term follow up. The investigations included body plethysmography, flow-volume relation, effect of bronchodilator, bronchial challenge and endoscopic estimation of the tracheal diameter. Tracheal sleeve resection in stenosis doubles the tracheal diameter from 5.9 to 11.0 mm. Resistance parameters and forced expiratory flow values reflected the significant improvement best. Airway structure remains stable during long-term follow-up, and effort-dependent parameters improve further. Compared to normal volunteers with artificially induced stenosis patients show a higher tolerability for airway narrowing. A tracheal diameter of 5 mm produces severe complaints and distinct functional distortions which are shown in specific airway resistance of 7.5 cm H₂O^-1•s, specific airway conductance of 0.02 cm H₂O•s^-1 and FEV₁ of 1 l•s^-1. These values are absolute indications for resection. Tracheal stenosis after long-term artificial respiration can be influenced slightly by bronchodilator therapy. Nonspecific bronchial hyperreactivity is present, suggesting increased reagibility of the bronchial smooth muscles.

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Slide Tracheoplasty Applied to Acquired Subglottic and Upper Tracheal Stenosis

Abdelkafy

Atriby²,

Iskandar³

et al. 2007

Arch Otolaryngol Head Neck Surg

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To assess the applicability and complications of slide tracheoplasty in the management of subglottic and upper tracheal stenosis in experimental animals. Design: Subglottic stenosis was induced in 10 dogs by cauterizing the subglottic area and the upper 3 to 4 cm of the trachea. After 21 days, the severity of stenosis ranged from 30% to 60%. The subglottic area was reconstruction with slide tracheoplasty, and the results were evaluated at 4, 12, and 24 weeks postoperatively. Subjects: Ten mongrel dogs (Canis familiaris) were included in the study, each weighing between 12 and 17 kg. Intervention: Slide tracheoplasty. Main Outcome Measure: Patency of the reconstructed segment. Results: Follow-upexaminationrevealednoairwayobstruction in any animal. Examination of the reconstructed segment revealed good healing without granulation tissue and a patent endotracheal lumen in all cases. Histopathological examination of sections taken at the suture line confirmed complete healing without granulation tissue. Conclusions: Slide tracheoplasty can be applied successfully to the subglottic area. It offers many advantages in tracheal reconstruction and can be used for the management of acquired subglottic stenosis. The vascularized tracheal cartilage heals without granulation tissue often seen after cartilage interposition grafts. Furthermore, this technique reduces the need for tracheal and laryngeal mobilization for the treatment of longer areas of stenosis.

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Laryngotracheal obstruction complicating tracheostomy or endotracheal intubation with assisted respiration. A critical review.

Cited by 75 publications

References 137 publications

Ulcerative tracheo-oesophageal fistula during treatment by tracheostomy and intermittent positive pressure ventilation

Ulcerative tracheo-oesophageal fistula during treatment by tracheostomy and intermittent positive pressure ventilation

Effects of Surgery on Airway Mechanics in Tracheal Stenosis

Slide Tracheoplasty Applied to Acquired Subglottic and Upper Tracheal Stenosis

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