Risk factors for adult acquired subglottic stenosis

Nicolli, Elizabeth A.; Carey, Ryan M.; Farquhar, Douglas R.; Haft, Sunny; Alfonso, K P; Mirza, Natasha

doi:10.1017/s0022215116009798

Cited by 34 publications

(37 citation statements)

References 20 publications

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“…GERD has been suggested to contribute to the pathophysiology of SGS. Reports of its coexistence in patients with SGS range from 45% to 69%, 9,10,13 and our results (60.4%) are consistent with this. However, for the purpose of this study, the presence of GERD was assumed if patients were listed in the electronic medical record as taking an antireflux medication.…”

Section: Discussionsupporting

confidence: 92%

Subglottic stenosis: An evaluation of an elderly treatment‐seeking population

2018

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Objectives/Hypothesis To evaluate the demographics, etiology, intraoperative findings, and treatment outcomes of patients with subglottic stenosis (SGS), comparing those patients aged <65 years to an elderly population aged ≥65 years. Study Design Retrospective cohort study. Methods Nine‐year retrospective review of patients with SGS. Forty‐eight adults presented for evaluation and treatment of SGS between January 2008 and December 2016. At the time of presentation, 41 were aged <65 years and seven were aged ≥65 years. Results Comparing the aged <65 years group to the aged ≥65 years group, the etiology was idiopathic SGS in 50.0% versus 42.8%, intubation‐related SGS in 22.5% versus 28.6%, and granulomatosis with polyangiitis in 27.5% versus 28.6%, respectively. No statistically significant difference was noted in the two groups when comparing the demographics, etiology, treatment, intraoperative findings, or intertreatment interval (ITI). Conclusions We sought to analyze an older patient population with SGS and found no statistically significant differences compared to a younger population. ITI trended toward older patients requiring surgery more frequently but was not significant. Level of Evidence 4 Laryngoscope, 129:1155–1158, 2019

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Section: Discussionsupporting

confidence: 92%

Subglottic stenosis: An evaluation of an elderly treatment‐seeking population

2018

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“…Age, obesity, longer duration of MV, previous history of MV, and more than once endotracheal tube change during the period of mechanical ventilation were found as possible risk factors for post-intubation stenosis. In previous studies, tracheal tube size, material of tube cuff [19], female gender [20], obesity [21], and smoking [22] were possible risk factors of post-intubation stenosis.…”

Section: Discussionmentioning

confidence: 95%

Ultrasound as a bedside tool for diagnosis of post-intubation tracheal stenosis

et al. 2020

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Background Screening of post-intubation stenosis can allow early diagnosis, early management of stenosis, and possible prevention of progress. Fiberoptic bronchoscope is the gold standard for diagnosis of tracheal stenosis. Other imaging modalities as computed tomography can be considered but are not available in intensive care unit. Purpose of the study To evaluate the validity of ultrasound (US) as a bedside test for early diagnosis of post-intubation stenosis compared to multidetector computed tomography (MDCT) and fiberoptic bronchoscope (FOB). Results Out of the 50 included patients, 12 patients were found to have definite stenosis by FOB. Compared to CT, significant positive correlation was found between all ultrasound parameters (laryngeal width, tracheal diameter) and corresponding CT parameters (r = 0.798, p < 0.001; r = 0.714, p < 0.001 respectively). Compared to FOB results, the yield of MDCT chest for diagnosis of stenosis had 91.6% sensitivity and 100% specificity, while the yield of US detected by mucosal irregularity as a diagnostic tool for tracheal stenosis had comparable sensitivity (91.6%) but lower specificity (88.9%). Conclusion Due to its high sensitivity, US could help in detection of possible post-intubation laryngotracheal stenosis in critically ill MV patients.

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“…The ring cartilage reacts particularly sensitively to local trauma with the development of recurrent tracheal stenosis caused by excessive regeneration processes with osteoid expression of osteoblasts and mineralization in an acidic environment [25]. Beyond the tracheotomy technique, overweight, diabetes and reflux, accompanied by chronic inflammatory reactions, are risk factors for the development of subglottic stenosis [26]. A recent analysis of 262 cases suggested that COPD, nicotine abuse, OSAS, hypertension and microcirculation disorders are the comorbidities responsible for the development of laryngotracheal stenosis following tracheostomy [27].…”

Section: Discussionmentioning

confidence: 99%

Safety of percutaneous dilatational tracheotomy (PDT) with the rigid tracheotomy endoscope (TED): a 6-month follow-up multicenter investigation

et al. 2021

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Background The rigid tracheotomy endoscope (TED) was recently introduced to improve the fiberoptic technique during percutaneous dilatational tracheotomy (PDT) in critically ill patients. The aim was to evaluate the long-term complications of PDT using TED equipment in a prospective multicenter investigation. Methods One hundred eighty adult patients underwent PDT using TED in four German hospitals. Patients who were alive or their guardians were contacted via telephone and interviewed using a structured questionnaire 6 months following the tracheostomy procedure. Patients with airway complaints were invited for outpatient clinical ENT examination. The incidence of adverse events related to PDT was registered. Results Of 180 patients who received tracheostomy, 137 (76.1%) were alive at the time of follow-up. None of the 43 lethal events was related to the PDT. Fifty-three (38.7%) patients were available for follow-up examination, whereas 14 (10.2%) were able to visit ENT physicians. Two (3.8%) out of 53 patients developed tracheocutaneous fistula with required surgical closure of tracheostoma. Dyspnea (7.5%), hoarseness (5.7%), stridor and swallowing difficulties (both with 3.8%) were the most common complaints. Tracheal stenosis was confirmed in 1 patient (1.88% [95% CI: 0.33; 9.93]). Conclusion The use of TED for PDT in the clinical setting is safe regarding adverse events at 6-month follow-up. The incidence of tracheal stenosis after PDT with TED is comparable with that of flexible bronchoscopy; however, its role for PDT at the intensive care unit should be clarified in further investigations.

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Risk factors for adult acquired subglottic stenosis

Abstract: Obesity and diabetes are significant risk factors for acquiring subglottic stenosis. Further investigations are required to determine if obesity is also a predictor for failed tracheostomy decannulation in subglottic stenosis.

Cited by 34 publications

References 20 publications

Subglottic stenosis: An evaluation of an elderly treatment‐seeking population

Subglottic stenosis: An evaluation of an elderly treatment‐seeking population

Ultrasound as a bedside tool for diagnosis of post-intubation tracheal stenosis

Safety of percutaneous dilatational tracheotomy (PDT) with the rigid tracheotomy endoscope (TED): a 6-month follow-up multicenter investigation

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