Management of Benign Stenoses of the Large Airways in the University Hospital in Prague, Czech Republic, in 1998–2003

Abstract

Background: Clinically significant benign stenoses of the large airways develop in about 1% of patients after intubation. The management of benign stenoses is not unified around the world, nor are there any accepted methods for their screening. Objectives: The purpose of this study is to describe and compare results of interventional bronchoscopy and surgical therapy of benign stenoses as well as to propose an algorithm for the management of this airways disorder. Methods: Prospective study on 80 consecutive patients with benign stenoses of the large airways admitted to the Pulmonary Department of the University Hospital of Prague-Motol. Results: Sixty-two patients developed stenoses after endotracheal intubation or tracheostomy, in 18 patients the stenosis was caused by other diseases or pathological situations. Thirty-eight patients were sent for surgical resection of the stenotic part of the airways. 2 surgically treated patients developed recurrence of the stenosis and had to be reoperated on. Narrowing of the trachea at the site of end-to-end anastomosis developed in 6 other patients and was cured by interventional bronchoscopy. The remaining 42 patients were treated by interventional bronchoscopy (Nd-YAG laser, electrocautery, stent) which was curative in 35 patients. Sixty-five patients were alive at the time of evaluation, 15 patients died. Five of them died between 3 and 14 (median 4) months after surgery from a disease other than airway stenosis. Ten nonresected patients also died, with 1 exception, due to a disease other than airway stenosis; the median survival was 9 months. Conclusions: We recommend to assess the patient for surgery after the initial diagnosis and therapeutic bronchoscopy with dilatation of the stenosis. If the patient is not a suitable candidate for resection, interventional bronchoscopy is an appropriate alternative for the management of benign stenoses of the large airways.

Prognostic Factors for Endotracheal Silicone Stenting in the Management of Inoperable Post-Intubation Tracheal Stenosis

“…Surgical resection and re-anastomosis have been the first choice of treatment when the patients' condition is tolerable, and interventional bronchoscopy has been applied if the general condition is impossible for an operation 9. However, even with developments in the management of critically ill patients, surgical treatment is still not indicated in PITS patients with poor neurological, cardiovascular, or respiratory condition 10.…”

British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults

“…The prospective management of benign stenoses using electrocautery28 is effective. It has also been used for removal of granulation tissue and removal with curative intent of both benign and early stage malignant tumours with a visible distal margin and <3 mm invasion of the bronchial mucosa and no invasion of the cartilage 27.…”

Acquired tracheoesophageal fistula with undiagnosed tracheal stenosis: A simple innovation to avoid tracheostomy!

“…History of prolonged intubation is the most common cause of tracheal stenosis. [2] The usual site of TOF and tracheal stenosis secondary to prolonged intubation is the site of cuff inflation[3]. However, in our case, tracheal stenosis was encountered approximately 1–2 cm DTF.…”