Management of subglottic stenosis in pregnancy using advanced apnoeic ventilatory techniques

Abstract

ObjectiveTo describe the use of balloon dilation with non-invasive ventilation in the treatment of pregnant patients with idiopathic subglottic stenosis.MethodsThe medical charts of four consecutive patients who underwent jet ventilation or high-flow nasal cannula oxygenation with balloon dilation for the treatment of idiopathic subglottic stenosis during pregnancy were reviewed.ResultsObjective improvement of subglottic stenosis was seen in all four cases, with end-result Myer–Cotton grade 1 lesions down from pre-procedure grade 3 lesions. Patients also reported subjective improvements in symptomatology, with no further airway issues. All patients delivered normally, at term.ConclusionLaryngeal dilation with continuous radial expansion pulmonary balloons using non-invasive ventilation for the treatment of idiopathic subglottic stenosis in pregnant patients is safe and efficacious, and should be the first line treatment option for this patient population. The improvement in symptoms, and lack of labour and pregnancy complications, distinguish this method of treatment from others reported in the literature.

Transnasal Humidified Rapid Insufflation Ventilatory Exchange With Nasopharyngeal Airway Facilitates Apneic Oxygenation: A Randomized Clinical Noninferiority Trial

“…The study of Mir ( 19 ) showed that THRIVE was a practical method for pre-oxygenating patients for rapid sequence induction. HFNO can also be used in patients with airway stenosis ( 8 ), such as subglottic stenosis ( 9 – 11 ) and tracheal stenosis caused by thyroid tumor ( 12 ).…”

Reliability of peak expiratory flow percentage compared to endoscopic grading in subglottic stenosis

“…4 Current studies use the subjective Cotton-Myer grade or estimated percent obstruction (% stenosis) as the exclusive objective outcome measure in the management of adult subglottic stenosis. [5][6][7] These studies assume that endoscopic grading is sufficient in following patients with subglottic stenosis.…”

Safety standards for invasive procedures in out-patient departments, managing subglottic stenosis in pregnancy, a critical review on follow up of head and neck cancer patients, and a new classification for cochleovestibular malformations

“…The presence of subglottic stenosis in pregnant women is significant and rare, and may lead to a life-threatening delivery; 2 management therefore requires expertise. Damrose and colleagues 3 describe their use of balloon dilatation with non-invasive ventilation techniques in the treatment of pregnant patients with idiopathic subglottic stenosis. There is limited experience in the management of this condition, so this paper is an excellent addition to our knowledge.…”