Role of Topical Medication in Prevention of Post-extubation Subglottic Stenosis

Saravanam, Prasanna Kumar; Ravikumar, A.; Thanka, J

doi:10.1007/s12070-017-1056-y

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…The rabbits receiving topical steroids had less respiratory distress than those receiving mitomycin‐C or controls. Histopathologic analysis also demonstrated that triamcinolone acetonide application altered wound healing, whereas mitomycin‐C application did not 21 . Cincik et al reported decreased fibrosis after subglottic trauma in rabbits treated with mitomycin‐C or 5 fluorouracil/triamcinolone injection as compared with controls, with no difference between the effects of the 2 drugs 22 .…”

Section: Discussionmentioning

confidence: 99%

“…Histopathologic analysis also demonstrated that triamcinolone acetonide application altered wound healing, whereas mitomycin-C application did not. 21 Cincik et al reported decreased fibrosis after subglottic trauma in rabbits treated with mitomycin-C or 5 fluorouracil/triamcinolone injection as compared with controls, with no difference between the effects of the 2 drugs. 22 We believe that there may be an effect by ciprofloxacin on the bacterial load at the sight of airway injury, which acts synergistically with the anti-inflammatory effect of the dexamethasone.…”

Section: Discussionmentioning

confidence: 99%

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Randomized Controlled Trial of Balloon Dilation in Treatment of Subglottic Stenosis With a Rabbit Model

Wistermayer

McIlwain

Escalante

et al. 2020

Otolaryngol.--head neck surg.

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Objectives Identify the effects of balloon dilation duration and topical ciprofloxacin-dexamethasone application in treatment of subglottic stenosis. Study Design Randomized controlled trial. Setting Animal research facility. Subjects and Methods Forty-four rabbits underwent subglottic injury in an Institutional Animal Care and Use Committee–approved study. One week after injury, the subglottis of each rabbit was measured and treated with endoscopic balloon dilation for 2 rounds of short duration (SBD; 3 seconds), long duration (LBD; 30 seconds), or LBD with topical ciprofloxacin-dexamethasone application (LBD+C). The subglottis of each rabbit was remeasured at the study endpoint: 1 month postdilation or following development of life-threatening respiratory distress. Results Of 44 rabbits, 35 (80%) survived to endoscopic balloon dilation, with 21 rabbits developing a grade III Cotton-Myer stenosis. Prior to dilation, there was no difference in stenosis rates among groups (all subjects, P = .99; grade III stenosis only, P = .52). Among grade III subjects, improvement in stenosis after dilation was –1% (SD, 21%) for SBD, 27% (SD, 38%) for LBD, and 58% (SD, 29%) for LBD+C ( P = .01). Early euthanasia/death rates among grade III subjects were 85% for SBD, 63% for LBD, and 17% for LBD+C ( P = .03). Time to early euthanasia/death was 5.0 days for the SBD group and 8.4 days for the LBD group ( P = .04). Conclusion SBD was inferior to LBD or LBD+C in multiple metrics. LBD+C offered significant improvements in stenosis size and mortality over the SBD group and had the lowest rate of early mortality. Further research is needed to identify optimal balloon dilation treatment duration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial of Balloon Dilation in Treatment of Subglottic Stenosis With a Rabbit Model

Wistermayer

McIlwain

Escalante

et al. 2020

Otolaryngol.--head neck surg.

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“…8 A 2017 study by Kumar demonstrated a significant decrease in respiratory distress in rabbits treated with topical triamcinolone compared to controls. 9 Sekioka et al found that serial triamcinolone acetide injections in infants with ASGS led to improvements in the patency of the subglottis. 10 However, not all studies have found post-injury steroids to be efficacious.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Dexamethasone as a Prophylactic Treatment for Subglottic Stenosis in a Rabbit Model

Wistermayer

Escalante

McIlwain

et al. 2020

Ann Otol Rhinol Laryngol

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Objective: Iatrogenic injury is a common cause of subglottic stenosis (SGS). We investigated the role of pre-injury dexamethasone as a preventive treatment for iatrogenic subglottic stenosis. Methods: 16 New Zealand White rabbits were used in an IACUC approved study. Subjects were divided into two groups: intramuscular dexamethasone (DEX) at a dose of 2 mg/kg 15 minutes prior to an endoscopic injury to create SGS, and the same injury creation with a preoperative intramuscular saline (SAL) injection. Three independent, blinded raters evaluated endoscopic images to obtain cross sectional area (CSA) airway measurements. Rabbit airways were measured just prior to injury and at one week post-injury. All subjects were provided as-needed postoperative steroids and buprenorphine for symptoms of respiratory distress. Data analysis was performed using Student t-test. Intraclass correlation coefficients were used to assess inter-rater agreement. Results: All subjects survived to the one-week post-injury airway evaluation. There was no difference in airway size between groups prior to injury ( P = .28). Subjects in the DEX group demonstrated an average stenosis of 20.3% (95% CI 10.2-30.5) at one week compared to 60.6% (95% CI 40.3-80.9) in the SAL group ( P = .01). Subjects in the control group required significantly more doses of postoperative dexamethasone ( P = .02). Inter-rater agreement for between raters was excellent (ICC = .88). Conclusion: This is the first study to examine the role of pre-injury glucocorticoids in preventing iatrogenic subglottic stenosis. In our model, a single dose of intramuscular dexamethasone given prior to a subglottic injury resulted in a statistically significant reduction in airway stenosis. This research suggests that administering systemic dexamethasone should be considered prior to any procedure that may injure the subglottis, including traumatic intubation, to prevent iatrogenic subglottic stenosis.

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“…A recent randomized controlled animal study describes the role of MMC and triamcinolone acetonide in rabbits with subglottic injury . The rabbits were divided into control, MMC only, steroid only, and MMC with steroid groups.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial of adjuvant mitomycin‐c in endoscopic surgery for laryngotracheal stenosis

2019

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Objectives/Hypothesis Topical mitomycin‐C (MMC) application is a commonly accepted adjuvant therapy in the surgical treatment for laryngotracheal stenosis (LTS). However, the efficacy of MMC has not been examined in a prospective, randomized clinical trial in humans. We aimed to examine the efficacy of MMC in the treatment of LTS patients as compared to a placebo‐controlled group. Study Design Prospective, randomized, double‐blind, placebo‐controlled clinical trial. Methods Fifteen patients with LTS were enrolled in a 24‐month trial and randomized into one of two groups: 1) endoscopic surgical treatment with topical application of MMC or 2) endoscopic surgical treatment with topical application of saline. Postoperatively, patients were evaluated at standardized intervals with a symptom questionnaire and spirometry. Subsequent surgery was performed as needed based on relapse of stenosis on exam and patient‐reported symptom severity. Results The average interval between surgical treatments was 17.9 months in the placebo group and 17.4 months in the MMC group (P = .95). There was no difference in magnitude of peak inspiratory flow (PIF) improvement between groups. The average magnitude of PIF change was 1.3 L/sec and 1.1 L/sec for the placebo and MMC groups, respectively (P = .64). Similarly, there was no difference in magnitude of symptom improvement or duration of symptom improvement between the two groups. Conclusions This prospective, randomized. double‐blind. placebo‐controlled trial suggests that the use of MMC as a topical adjuvant therapy has no additional benefit in the endoscopic surgical management of LTS. Further study is needed. Level of Evidence 1b Laryngoscope, 130:706–711, 2020

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Role of Topical Medication in Prevention of Post-extubation Subglottic Stenosis

Cited by 5 publications

References 27 publications

Randomized Controlled Trial of Balloon Dilation in Treatment of Subglottic Stenosis With a Rabbit Model

Randomized Controlled Trial of Balloon Dilation in Treatment of Subglottic Stenosis With a Rabbit Model

A Randomized Controlled Trial of Dexamethasone as a Prophylactic Treatment for Subglottic Stenosis in a Rabbit Model

A randomized controlled trial of adjuvant mitomycin‐c in endoscopic surgery for laryngotracheal stenosis

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