Management of Post-intubation and/or Tracheotomy Tracheal Stenoses

Foccoli, Pierfranco; Scappaticci, E; Rea, Federico; Revello, F; Bezzi, Michela; Cavaliere, Sergio

doi:10.4081/monaldi.2011.248

Cited by 3 publications

(6 citation statements)

References 26 publications

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“…This study showed that stent placement, with removal 1 year later, had a better effect on long-term stabilisation of tracheal patency in respect to balloon dilatation technique, also in patients with complex stenosis (19). The stent was a temporary item aimed at defending the airway calibre, till the fibrocicatricial process end, as reported by several authors (5)(6)(7)(8), and for this reason silicon stent was recommended because it could be easily removed, in respect to metallic or combined ones. Also in the study of D'Andrilli et al, restenosis after surgical intervention (8 cases) was treated with laser-assisted dilatation and silicon stent positioning (15).…”

Section: Comparison With Similar Researchessupporting

confidence: 52%

“…Surgery is the first line of treatment for tracheal stenosis and leads to a high rate of success (2,3). In recent years, the interest for endoscopic treatment modalities has increased (4)(5)(6)(7)(8), with the aim to treat patients with benign subglottic stenosis not yet stabilized, avoiding the need of a tracheostomy, which would complicate surgical repair. Laser-assisted endoscopy, with or without stenting, has however rarely been used in subglottic stenosis for anatomical and technical reasons (9).…”

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary treatment of benign tracheal stenosis—a case report

Fanucchi¹,

Picchi²,

Marrama³

et al. 2023

J Vis Surg

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Background: Benign stenosis involving the subglottic region represents a major therapeutic challenge.Surgery is the first line of treatment for laryngotracheal stenosis and leads to a high rate of success. Additionally, endoscopic treatment plays an important role for not yet stabilized subglottic stenosis and management of restenosis.Case description: We report a case of a 60-year-old male that came to our attention with a tracheotomy and subglottic stenosis, related with a previous recovery in an intensive care unit for a myasthenic crisis, that required prolonged intubation. The distinctiveness of this challenging case was represented not only by the length of tracheal resection and the presence of tracheotomy, but also by comorbidities (myasthenia gravis, diabetes mellitus associated with steroid therapy). A multidisciplinary approach was permitted to treat the complex tracheal stenosis with surgical intervention (resection/anastomosis) and to manage the postoperative course that was complicated by wound infection and a progressive restenosis. This complication required endoscopic treatments: firstly balloon dilatation and then stent positioning with rigid bronchoscope. Conclusions:The innovation in respiratory-intensive-care units allowed a prolonged management of mechanical ventilation. Thus, the number of patients that underwent prolonged intubation and/or percutaneous tracheotomy has increased. In our case, the damage to tracheal wall was related to the cuff pressure of orotracheal tube and to the emergency tracheotomy. This fact determinated an increase of tracheal length to be resected. Partial dehiscence and subsequent restenosis are some of the most frequent complications described in the literature (1.5-13.4%). In these cases, the endoscopic approach represented the only possible conservative way to manage the critical situation, aimed to avoid re-tracheotomy, which probably would have been permanent. In some cases, as well as in our one, stent positioning was required in order to stabilise the tracheal wall. Currently, the patient has no symptoms and bronchoscopy showed stent in place without granulomatous tissue. In this case, the surgical resection/anastomosis could not achieve definitive results, the endoscopic approach played an important role in complications management, permitting to restore patency of the airway without tracheostomy, with the aim to remove the stent 10-12 months later. The multidisciplinary approach does not represent the unique point in this manuscript, however it could be seen as key for challenging cases.

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Section: Comparison With Similar Researchessupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Multidisciplinary treatment of benign tracheal stenosis—a case report

Fanucchi¹,

Picchi²,

Marrama³

et al. 2023

J Vis Surg

View full text Add to dashboard Cite

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“…Repeated procedures also are not recommended due to the risk of devascularization [ 6 ]. Some authors have reported a successful rate of 100% in cases of web-like stenosis and in few cases of complex stenosis, treated with endoscopic treatment as laser and stenting, and recommended these treatment in cases of high risk patients or excessive length stenosis not suitable for surgery [ 7 , 8 ]. Bourinet et al recently analyzed their experience with transcordal silicone stents in adult laryngotracheal stenosis reporting low morbidity and excellent clinical outcomes on long term follow up [ 9 ].…”

Section: Main Textmentioning

confidence: 99%

State of the art in tracheal surgery: a brief literature review

Siciliani

Rendina

Ibrahim

2018

Multidiscip Respir Med

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BackgroundTracheal surgery requires a highly specialized team of anesthesiologists, thoracic surgeons, and operative support staff. It remain a formidable challenge for surgeons due to the criticality connected to anatomical considerations, intraoperative airway management, technical complexity of reconstruction, and the potential postoperative morbidity and mortality.Main bodyThis article focuses on the main technical aspects and literature data regarding laryngotracheal and tracheal resection and reconstruction. Particular attention will be paied to anastomotic and non-anastomotic complications.Short conclusionResults from literature confirm that, when feasible, laryngotracheal and tracheal resection and reconstruction is the treatment of choice in cases of benign stricture and malign neoplasm. Careful patient selection, operative planning, and execution are required for optimal results.

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“…2%–3% of patients who undergo intubations and/or tracheostomy develop tracheal stenosis. [ 10 ] The tracheal stenosis is classified as simple, which is a soft, short segment web-like narrowing often limited to the mucosa only or complex stenosis, which is a hard, long-segment stricture with destruction of tracheal cartilages and fibrosis. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 16 ] Multiple recent studies also stress on the use of endoscopic intervention in simple stenosis only. [ 10 15 ] It is important to highlight here that all our patients were having complex stenosis and 17 out of 18 patients had history of failed endoscopic interventions. Endotracheal prosthesis (stents) should not be used as a definitive treatment in benign tracheal stenosis.…”

Section: Discussionmentioning

confidence: 99%