Management of post-intubation tracheal stenoses using the endoscopic approach

Cavaliere, Sergio; Bezzi, Michela; Toninelli, Carlo; Foccoli, Pierfranco

doi:10.4081/monaldi.2007.492

Cited by 44 publications

(67 citation statements)

References 28 publications

(42 reference statements)

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“…In addition, because of the predominant dynamic component of the stenosis and the absence of concentric scarring, stent migration is frequent. For these reasons, DATS are frequently excluded from endoscopic management studies [12,[20][21][22]24].…”

Section: Commentmentioning

confidence: 99%

“…However, some patients are not considered candidates for surgery because of the extent of the stenosis (> 50% of the trachea or multifocal involvement) or because of any surgical contraindication. Endoscopic techniques have been developed as an alternative treatment [12,[18][19][20][21][22][23][24][25][26]. Dilatation, laser photo resection, and stent placement are the mainstay of endoscopic treatment strategy and afford excellent clinical results.…”

mentioning

confidence: 99%

“…Dilatation, laser photo resection, and stent placement are the mainstay of endoscopic treatment strategy and afford excellent clinical results. An attempt to definitively remove the stent after 12 to 18 months is generally provided with variable longterm success (40% when the stent is placed for 6 months,70% when it remains in place for 18 months) [12,[20][21][22]. Restenosis after stent removal is reported in up to 80%, requiring permanent stent placement or second line surgery [20].…”

mentioning

confidence: 99%

“…An attempt to definitively remove the stent after 12 to 18 months is generally provided with variable longterm success (40% when the stent is placed for 6 months,70% when it remains in place for 18 months) [12,[20][21][22]. Restenosis after stent removal is reported in up to 80%, requiring permanent stent placement or second line surgery [20]. The major drawback of stents is the possibility of migration, which happens in about 11% to 20% of all cases [12,21,26].…”

mentioning

confidence: 99%

“…Patients suffering from DATS are frequently excluded from studies describing endoscopic management of BTS [12,[20][21][22]24]. As a matter of fact, DATS are not treatable with dilatation as there is no shrinking or scarring of trachea.…”

mentioning

confidence: 99%

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Management of Benign Dynamic “A-Shape” Tracheal Stenosis: A Retrospective Study of 60 Patients

Plojoux¹,

Laroumagne²,

Vandemoortele

et al. 2015

The Annals of Thoracic Surgery

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Background. Benign tracheal stenosis complicates tracheal intubation or tracheostomy in 0.6% to 65% of cases. Surgical resection is the standard treatment. Endoscopic management is used for inoperable patients with 17% to 69% success. Dynamic "A-shape" tracheal stenosis (DATS) results in a dynamic stenosis with anterior fracture of tracheal cartilage and frequently associated posterior malacia. We report the results of our multidisciplinary management.Methods. Sixty patients with DATS were included. Management decision was made during initial bronchoscopy. When suitable, patients were referred to thoracic surgery for tracheal resection. Posterior localized tracheomalacia was treated with laser photocoagulation of the posterior tracheal wall. Tracheal stents were placed if the stenosis persisted after laser treatment. The choice of stent (straight silicone, hour-glass shaped silicone, Ttube, or fully-covered self-expandable metallic stent) was based on operator's judgment. After 12 to 18 months, stents were removed. If the stenosis persisted after stent removal, surgery was reconsidered. If surgery was not possible, a stent was replaced. In case of satisfactory

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Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Management of Benign Dynamic “A-Shape” Tracheal Stenosis: A Retrospective Study of 60 Patients

Plojoux¹,

Laroumagne²,

Vandemoortele

et al. 2015

The Annals of Thoracic Surgery

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Early versus late tracheostomy for critically ill patients

Andriolo

Saconato³

et al. 2015

Cochrane Database of Systematic Reviews

293

260

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Pediatric tracheostomy: A large single‐center experience

et al. 2019

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Objectives: To describe the epidemiology, specifically the indications, complications, and outcomes, of pediatric tracheostomies performed in one tertiary referral unit.Methods: Single-center retrospective cohort study of pediatric patients undergoing tracheostomy between May 2010 and May 2018 at the Newcastle upon Tyne Hospitals, United Kingdom.Results: One hundred seventy-two pediatric tracheostomies were performed during the study period with a median age of 141 (interquartile range [IQR] 51-484) days. The most common primary indication was long-term ventilation (38.4%, 66 of 172), followed by weaning from ventilation in cardiac patients (22.1%, 38 of 172). Only 5.2% (9 of 172) of our cohort underwent tracheostomy for subglottic stenosis. The vast majority of tracheostomies were performed electively, with just 6.4% (11 of 172) performed as an emergency procedure. Early and late complication rates were 9.8% (15 of 153) and 40.0% (61 of 153), respectively. Tracheostomy decannulation was successful in 44.4% of children (68 of 153). The median duration the tracheostomy was in situ was 397 (IQR 106-708) days. All-cause mortality was 22.1% (38 of 172), with tracheostomy-related mortality at 1.2% (2 of 172).Conclusion: We report one of the largest contemporary case series of pediatric tracheostomies. Present-day pediatric tracheostomy is primarily performed as an elective procedure in ventilated children under the age of 1 year. Pediatric tracheostomy should be considered as a long-term intervention in many children. Nevertheless, a large proportion of children are ultimately decannulated. It is important to acknowledge the significant morbidity associated with this intervention and the small-but-present risk of tracheostomy-related mortality.

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Management of post-intubation tracheal stenoses using the endoscopic approach

Abstract: Our results indicate that the endoscopic treatment of post-intubation tracheal stenoses performed in an expert setting can be considered a safe first-line therapy, leaving some selected cases and the relapsing stenoses, for surgical resection.

Cited by 44 publications

References 28 publications

Management of Benign Dynamic “A-Shape” Tracheal Stenosis: A Retrospective Study of 60 Patients

Management of Benign Dynamic “A-Shape” Tracheal Stenosis: A Retrospective Study of 60 Patients

Early versus late tracheostomy for critically ill patients

Pediatric tracheostomy: A large single‐center experience

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