Tracheal Stenosis Complicating Tracheostomy With Cuffed Tubes

Pearson, F.G.; Goldberg, Melvyn; Silva, A. J. da

doi:10.1001/archsurg.1968.01340030040002

Cited by 127 publications

(16 citation statements)

References 8 publications

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“…Circumferential damage without significant erosion into cartilage has been shown to heal with dense fibrosis. Tracheal stenosis would be the consequence [147][148][149]. Proper attention to balloon cuff pressures has been shown to eliminate the development of these problems at the cuff site [134,143].…”

Section: Important Clinical Laryngeal Complications Of Translaryngealmentioning

confidence: 99%

Prolonged Intubation Versus Tracheostomy in the Adult

Colice

1987

J Intensive Care Med

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The development of mechanical ventilators that can en sure adequate respiration for long periods of time has led to the problem of determining how to best integrate patients into the machine's airflow circuits. Tracheal tubes with inflatable cuffs efficiently connect the patient to the machine, but the tubes may be placed in one of two ways. Each option has relative advantages and disad vantages. Translaryngeal intubation (TLI) can be per formed safety and quickly and is the preferred first step in airway management. However, when TLI is needed for prolonged periods, it may damage the larynx. Tra cheostomy, on the otherhand, has potential operative and tracheal complications, but presents little risk to the larynx and may be better tolerated by the patient requir ing long-term intubation. This review provides a histor ical background of these two methods and analyzes their respective advantages and complications. Guide lines for the optimal use of TLI and tracheostomy, par ticularly in adult patients requiring long-term intuba tion, are developed by comparing the risks and benefits of these two methods.

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Section: Important Clinical Laryngeal Complications Of Translaryngealmentioning

confidence: 99%

Prolonged Intubation Versus Tracheostomy in the Adult

Colice

1987

J Intensive Care Med

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“…Those distal post-tracheostomy lesions which occur in the area of the balloon cuff consist of (Fig. 1) stenosis, granulation mass formation, tracheomalacia, and perforation (Pearson, Goldberg, and da Silva, 1968;Stiles, 1965 (Atkins, 1964: Cooper and. This inflammatory condition leads to a superficial tracheitis and mucosal ulceration within the first week (Glas, King, and Lui, 1962).…”

Section: Post-tracheostomy Lesionsmentioning

confidence: 99%

“…This inflammatory condition leads to a superficial tracheitis and mucosal ulceration within the first week (Glas, King, and Lui, 1962). inflammation and superimposed infection may result in deeper mucosal ulcerations and exposure of the underlying cartilage in one to three weeks (Pearson et al, 1968). As the cartilage is exposed chondritis is seen.…”

Section: Post-tracheostomy Lesionsmentioning

confidence: 99%

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Radiological evaluation of post-tracheostomy lesions

As¹,

Ae²,

Fp³

et al. 1971

Thorax

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Post-tracheostomy lesions are becoming more commonplace and surgical techniques for definitive repair of these abnormalities are being developed. These lesions, in general, occur at two sites. the proximal lesions at the tracheostomy incision and the distal lesions 15 to 2-5 cm inferior in the area of the tracheostomy balloon cuff. Granuloma formation, stenosis, tracheomalacia, and perforation of the tracheal wall have been encountered in our experience. Clinical symptoms depend upon the type and location of the lesion as well as on the patient's awareness and physical activity. Radiological evaluation offers an accurate method to depict the anatomical and physiological alterations. This radiological assessment should begin with routine postero-anterior and lateral chest radiographs followed by fluoroscopy. Laminograms and special oblique views are often helpful. Contrast tracheograms using powdered tantalum allow good mucosal detail as well as excellent delineation of structural and physiological abnormalities.

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“…About 80%> of these stenoses are produced by intubation and long-term artificial respiration [3,7,12,18,22], Although a correlation between du-1 Supported by Arbeitsgemeinschaft zur Förde rung der Pneumologie an der Ruhrlandklinik e.V. ration of artificial respiration and stenosis is not evident, site and cuff pressure are im portant [3], Further, still unknown factors may also exist.…”

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confidence: 99%

Effects of Surgery on Airway Mechanics in Tracheal Stenosis

Petro¹,

Konietzko²,

Maassen³

1982

Respiration

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12 patients suffering from severe extrathoracic tracheal stenosis mainly caused by long-term artificial ventilation were investigated by comparing their airway mechanics before and after tracheal sleeve resection and during long-term follow up. The investigations included body plethysmography, flow-volume relation, effect of bronchodilator, bronchial challenge and endoscopic estimation of the tracheal diameter. Tracheal sleeve resection in stenosis doubles the tracheal diameter from 5.9 to 11.0 mm. Resistance parameters and forced expiratory flow values reflected the significant improvement best. Airway structure remains stable during long-term follow-up, and effort-dependent parameters improve further. Compared to normal volunteers with artificially induced stenosis patients show a higher tolerability for airway narrowing. A tracheal diameter of 5 mm produces severe complaints and distinct functional distortions which are shown in specific airway resistance of 7.5 cm H₂O^-1•s, specific airway conductance of 0.02 cm H₂O•s^-1 and FEV₁ of 1 l•s^-1. These values are absolute indications for resection. Tracheal stenosis after long-term artificial respiration can be influenced slightly by bronchodilator therapy. Nonspecific bronchial hyperreactivity is present, suggesting increased reagibility of the bronchial smooth muscles.

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Tracheal Stenosis Complicating Tracheostomy With Cuffed Tubes

Cited by 127 publications

References 8 publications

Prolonged Intubation Versus Tracheostomy in the Adult

Prolonged Intubation Versus Tracheostomy in the Adult

Radiological evaluation of post-tracheostomy lesions

Effects of Surgery on Airway Mechanics in Tracheal Stenosis

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