Tracheal stenosis in prolonged mechanically ventilated patients: prevalence, risk factors, and bronchoscopic management

Abstract

Background Various complications may arise from prolonged mechanical ventilation, but the risk of tracheal stenosis occurring late after translaryngeal intubation or tracheostomy is less common. This study aimed to determine the prevalence, type, risk factors, and management of tracheal stenoses in mechanically ventilated tracheotomized patients deemed ready for decannulation following prolonged weaning. Methods A retrospective observational study on 357 prolonged mechanically ventilated, tracheotomized patients admitted to a specialized weaning center over seven years. Flexible bronchoscopy was used to discern the type, level, and severity of tracheal stenosis in each case. We described the management of these stenoses and used a binary logistic regression analysis to determine independent risk factors for stenosis development. Results On admission, 272 patients (76%) had percutaneous tracheostomies, and 114 patients (32%) presented mild to moderate tracheal stenosis following weaning completion, with a median tracheal cross-section reduction of 40% (IQR 25–50). The majority of stenoses (88%) were located in the upper tracheal region, most commonly resulting from localized granulation tissue formation at the site of the internal stoma (96%). The logistic regression analysis determined that obesity (OR 2.16 [95%CI 1.29–3.63], P < 0.01), presence of a percutaneous tracheostomy (2.02 [1.12–3.66], P = 0.020), and cricothyrotomy status (5.35 [1.96–14.6], P < 0.01) were independently related to stenoses. Interventional bronchoscopy with Nd:YAG photocoagulation was a highly effective first-line treatment, with only three patients (2.6%) ultimately referred to tracheal surgery. Conclusions Tracheal stenosis is commonly observed among prolonged ventilated patients with tracheostomies, characterized by localized hypergranulation and mild to moderate airway obstruction, with interventional bronchoscopy providing satisfactory results.

Incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning

“…10 Airway obstruction following prolonged weaning is typically a consequence of granulation tissue forming at the site of the internal stoma. 11,35 Interventional bronchoscopy proved safe and effective in treating such tracheal stenoses, 11 explaining why airway obstruction accounted for only a small number of failed decannulations in the present analysis.…”

“…coughing), and (5) exclusion of airway obstruction (through flexible endoscopy of the upper airways, subglottic region, and trachea). 11 …”

“…Failure to decannulate may result from several reasons, such as severe dysphagia, retention of copious secretions requiring invasive airway clearing techniques, or tracheal stenosis, 11 but their frequency following prolonged mechanical ventilation is not known. Moreover, the factors associated with the main reasons for unsuccessful decannulation at an early stage of ventilator weaning have not been examined yet.…”

“…7 Still, only a few have focused on predictors of unsuccessful decannulation 3,[8][9][10] or the best approach to decannulation. 1 2 journals.sagepub.com/home/taj TherapeuTic advances in chronic disease clearing techniques, or tracheal stenosis, 11 but their frequency following prolonged mechanical ventilation is not known. Moreover, the factors associated with the main reasons for unsuccessful decannulation at an early stage of ventilator weaning have not been examined yet.…”

Glycosaminoglycan, Antimicrobial Defence Molecule and Cytokine Appearance in Tracheal Hyaline Cartilage of Healthy Humans

“…Tracheal diseases are still present, and the majority of them are associated with iatrogenic causes or trauma. For example, 1–3% of intensive care unit patients undergoing ventilation develop tracheobronchitis and up to 21% of intubated patients, and specifically 32% of patients with tracheostomies, develop tracheal stenosis [ 2 , 3 ]. Moreover, a study that was conducted in Germany by Schibilsky et al in 2020 showed that traumatic tracheobronchial injuries have a very high risk of mortality and mostly occur in males secondary to blunt trauma during accidents [ 4 ].…”