Multidisciplinary approach to management of postintubation tracheal stenoses

Abstract

The optimal management of postintubation tracheal stenosis is not well defined.A therapeutic algorithm was designed by thoracic surgeons, ear, nose and throat (ENT) surgeons, anaesthetists and pulmonologists. Rigid bronchoscopy with neodymium±yttrium aluminium garnet (Nd-YAG) laser resection or stent implantation (removable stent) was proposed as first-line treatment, depending on the type of stenosis (web-like versus complex stenosis). In patients with web-like stenoses, sleeve resection was proposed when laser treatment (up to three sessions) failed. In patients with complex stenoses, operability was assessed 6 months after stent implantation. If the patient was judged operable, the stent was removed and the patient underwent surgery if the stenosis recurred.This algorithm was validated prospectively in a series of 32 consecutive patients. Three patients died from severe coexistent illness shortly after the first bronchoscopy. Of the 15 patients with web-like stenosis, laser resection was curative in 10 (66%). Among the 17 patients with complex stenoses, three remained symptom-free after stent removal. Bronchoscopy alone was thus curative in more than one-third of the patients. Six patients underwent surgery, two after failure of laser resection and four after failure of temporary stenting. Surgery was always performed with the patient in good operative condition. Palliative stenting was the definitive treatment in nine cases. Tracheostomy was the definitive solution in two cases.This approach, including an initial conservative treatment, depending on the type of the stenosis, appears to be applicable to almost all patients and allows secondary surgery to be performed with the patient in good condition. Eur Respir J 1999; 13: 888±893.

Expression of Mesenchymal Stem Cell Phenotype in Human Nasal Respiratory Epithelial Cells

“…Each of these modalities has benefits and limitation (Epstein, 2005). Tissue engineering principles has been used to enhance the epithelial regeneration (Brichet et al, 1999). Complete reepithelialization of tracheal lesion is essential to produce functional tracheal substitute (Tan et al).…”

Management of Post-traumatic Laryngotracheal Stenosis: Our Experience

“…Early presentation of TS may include the patient being unable to be weaned off the ventilator, unable to be decannulated from the tracheostomy or patient presents with progressively worsening dyspnoea beginning 6 weeks to 2 months from successful extubation or decannulation [11].…”

“…Most common complications after any treatment modality is relapse and restenosis with recurrence within 1-3 months [11].…”

The use of self-expandable metallic stents in the airways in the adult population

“…One can divide post-intubation or post-tracheostomy tracheal stenosis (PITTS) into two different types: the web-like PITTS (disease of the tracheal mucosa sparing the cartilaginous rings) and the complex PITTS (involving deterioration of the cartilaginous support) [45]. The web-like PITTS is generally successfully treated by radial mucosal incisions followed by mechanical dilation [46].…”

“…For the complex PITTS, mechanical dilation alone is often not sufficient [45]. In case of surgical contraindication, the next step would be the placement of a stent in order to maintain the long-term patency of the tracheal lumen and prevent recurrence [45].The choice of the stent is important. Not fully covered SEMS have shown to make potentially operable PITTS inoperable because of the severe complications (such as expeditious fibrosis and scarring) associated with the technique [48].…”