Predictors of Tracheostomy Decannulation in Adult Laryngotracheal Stenosis

Abstract

Objective Predictors of tracheostomy decannulation in patients with laryngotracheal stenosis are not fully known, making prognosis difficult. The aim was to identify predictors of tracheostomy decannulation in adult patients with acquired stenosis of the larynx and/or trachea who were tracheostomy dependent. Study Design Case series. Setting Academic teaching hospital. Methods A total of 103 consecutive adult patients with laryngotracheal stenosis who were tracheostomy dependent and seen by the otolaryngology clinic from January 1, 2013, to August 2, 2018, were included. Exclusion criteria included age <18 years, history of laryngeal cancer or head and neck radiation, or history of laryngeal fracture. The primary outcome was the presence of tracheostomy at last follow-up. The patients’ etiology of stenosis, comorbid conditions, and characteristics of the stenosis were analyzed to determine if there was a statistically significant relationship with decannulation. Results A total of 103 patients were included: 67% of patients were women and the average age was 53.5 years. Sixty-four patients (62%) were successfully decannulated. In multivariate analysis, patients who were successfully decannulated presented to the otolaryngology clinic earlier after tracheostomy was performed, were more likely to have been intubated due to trauma, and were less likely to have gastroesophageal reflux disease. In patients with subglottic or tracheal stenosis, those with granulation tissue without firm scar were more likely to be decannulated, and those who underwent rigid dilation were less likely to be decannulated. Conclusion Early evaluation by an otolaryngologist may increase the likelihood of tracheostomy decannulation in patients with laryngotracheal stenosis. Patient comorbidities may assist in predicting which patients will be successfully decannulated.

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility

“… 17 Another study by Snow et al reported that for those with subglottic or tracheal narrowing, airway firm scarring as opposed to granulation had a greater association with tracheostomy dependence. 8 Applying this notion to PGS, significant scarring would be more likely to result in a higher Bogdasarian classification and increased likelihood of complete immobility. As Snow et al described for SGS and tracheal stenosis, we similarly identified a significant relationship on multivariate analysis between complete BVFI and decreased likelihood of decannulation.…”

“…Several studies have identified certain factors in patients with laryngotracheal stenosis that are associated with prolonged tracheostomy placement. 7 8 9 To date, only one study has evaluated risk factors solely in patients with a diagnosis of postintubation PGS. 5 The pathophysiology of this condition is unique, and factors associated with both the development and consequences of PGS after intubation may differ from other etiologies.…”

Corticosteroid Use in Otolaryngology: Current Considerations During the COVID‐19 Era

“…Laryngotracheal stenosis, which involves progressive airway fibrosis and narrowing, confers significant morbidity 16,105 . The resulting obstruction often necessitates intervention, 106‐110 with variable long‐term outcomes 111,112 . Intravenous corticosteroids have known efficacy in the treatment of acute airway edema and in prevention of postextubation laryngeal edema 11,113,114 .…”

“…16,105 The resulting obstruction often necessitates intervention, [106][107][108][109][110] with variable long-term outcomes. 111,112 Intravenous corticosteroids have known efficacy in the treatment of acute airway edema and in prevention of postextubation laryngeal edema. 11,113,114 However, prolonged use of SCSs for laryngotracheal stenosis is seldom indicated.…”

Interventions and Outcomes in Glottic Versus Multi‐level Airway Stenosis: A Multi‐institutional Review

“…10 Consequently, it is important to recognize and understand the differences in patients that may successfully undergo tracheostomy decannulation. 9 Prior literature has illustrated that patients diagnosed and treated for type I PGS show promise for excellent prognosis post-operatively with decannulation rates near 80%. 11 Also, a recent case series reported patients most likely to be decannulated after receiving a tracheostomy for laryngotracheal stenosis underwent early otolaryngologic evaluation and had minimal firm scar formation in their granulation tissue.…”