Postintubation tracheal stenosis in an 11‐year‐old boy: a surgical and anaesthetic challenge

Abstract

We present a case of postintubation tracheal stenosis in an 11-year-old boy occurring after a relatively short period of intubation. He had been intubated and ventilated in a paediatric intensive care unit after a road traffic accident. Clinical symptoms manifested by oxygen desaturation and wheeziness, finally leading to deterioration of the level of consciousness, occurred a few hours after the first attempt at extubation after 48 h requiring reintubation. Endoscopic examination performed a few weeks later revealed a tracheal stenosis. Consequently, he underwent an initial period of conservative treatment consisting of balloon dilatation and intralesional injection of steroids, followed by a tracheal resection and reconstruction. The anaesthetic management of patients with tracheal stenosis presenting for laryngo-tracheobronchoscopy and balloon dilatation is discussed.

ERS statement: interventional bronchoscopy in children

“…Balloon dilation has been used alone or with other techniques such as laser treatment [95][96][97], stent placement [98][99][100][101][102][103][104], mitomycin application [93], injection of intralesional corticosteroids [105] and by anaesthetists during VATS in children [106]. Serial balloon dilation has been used successfully to manage severe complications following slide tracheoplasty in children with congenital tracheal stenosis [97,104,105], to treat acquired tracheal [95,[107][108][109] or bronchial stenosis [110,111] and to treat stenosis due to granulation tissue after airway stenting [89].…”

Tracheal stenosis mimicking severe acute asthma

“…Our patient remained intubated for only 48 h. Only a handful of cases have been reported on tracheal stenosis developing in patients intubated for less than 48 h 7–9…”

A Case Report: An Acquired Tracheal Stenosis

“…Entübasyon tüp kafının trakeaya aşırı basınç uygulaması ile başlangıçta basit ödem gelişimi arkasından mukozal ulserasyon, perikondrit ve trakeal kartilajın lokal iskemik nekrozu ile oluşan granülasyon dokusu stenoza neden olmaktadır (4). İnfantlarda ve küçük çocuklarda stenozlar daha çok subglottik bölgede gözlenirken daha büyük çocuklarda lezyon genellikle trakeada yer almaktadır (5). Bizim olgumuzda stenoz subglottik bölgede idi.…”