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1.
Ther Adv Respir Dis ; 18: 17534666241254901, 2024.
Article in English | MEDLINE | ID: mdl-38785036

ABSTRACT

The two patients included in the study had mixed and refractory post-tuberculosis tracheobronchial stenosis (PTTS), having experienced unsuccessful interventional therapies such as balloon dilation and V-shaped stent placement before the operation. Following the secure placement of L-shaped silicone stents, examinations with a fiberbronchoscope during the first and third months post-operation revealed a significant reduction in bronchial mucosa inflammation for both patients. Additionally, the opening diameter of the upper and lower branch segments increased, and chest CT scans indicated a noticeable absorption of left pulmonary lesions. Three months post-operation, fiberbronchoscopy confirmed the stable fixation of the stent without any movement. The patients exhibited substantial improvements in pulmonary function, dyspnea index, and blood gas analysis, with no reported adverse complications. After 7 months, a follow-up fiberbronchoscope for one case revealed excellent stent fixation. Simultaneously, the chest CT scan indicated favorable re-expansion. The placement of L-shaped silicone stents proves effective in preventing displacement, alleviating airway stenosis or obstruction, and ensuring the safety and efficacy of PTTS treatment - particularly in cases where V-shaped silicone stent placement has failed. To our knowledge, this is the first study describing the L-shaped silicone stent in two patients with PTTS.


Successful treatment of severe airway narrowing due to tuberculosis using special L-shaped silicone stentsThis article tells the story of two patients who suffered from a complex lung condition called post-tuberculosis tracheobronchial stenosis (PTTS). Imagine your airways - the tubes that carry air to your lungs - getting severely scarred and narrowed due to a past bout with tuberculosis. These two patients had tried previous treatments like balloon dilation (where a small balloon is inflated inside the narrowed airway to widen it) and using V-shaped stents (flexible supports placed in the airway to keep it open), but these methods didn't provide lasting relief. In this innovative approach, doctors used L-shaped silicone stents specifically designed to fit in the affected parts of the patients' airways. After placing these stents, regular checks showed remarkable improvements. The swelling in the airway lining reduced significantly, and the openings leading to the upper and lower parts of the lungs got wider. Chest X-rays (CT scans) even showed that the patient's left lung was healing well. Three months later, the stents stayed firmly in place, and neither patient experienced any problems. Breathing became easier, lung function tests improved, and blood tests showed better oxygen levels. Seven months down the line, one patient continued to do extremely well, with the stent securely fixed and the chest scan showing good lung expansion. This groundbreaking study shows that using L-shaped silicone stents can effectively treat PTTS when other methods fail. Not only do they stay in place, preventing blockages, but they also safely and effectively alleviate narrowing of the airways. It's the first time such L-shaped stents have been used successfully in PTTS patients, offering new hope for those facing similar challenges.


Subject(s)
Bronchial Diseases , Bronchoscopy , Silicones , Stents , Tracheal Stenosis , Humans , Bronchial Diseases/etiology , Bronchial Diseases/therapy , Bronchial Diseases/physiopathology , Tracheal Stenosis/therapy , Tracheal Stenosis/etiology , Bronchoscopy/instrumentation , Male , Constriction, Pathologic , Female , Treatment Outcome , Adult , Middle Aged , Prosthesis Design , Tuberculosis, Pulmonary/complications , Tomography, X-Ray Computed
2.
BMJ Case Rep ; 17(5)2024 May 28.
Article in English | MEDLINE | ID: mdl-38806399

ABSTRACT

Increasing use of tracheal expandable metallic hybrid stents will lead to common encounters with these devices in emergency airway management. The presence of these stents qualifies any patient as a challenge when an emergency tracheostomy is needed. We report an unorthodox technique of tracheostomy with concomitant removal of tracheal stent, without any major complications. Although the combined approach with bronchoscopy and tracheostomy has been reported in similar cases, we present a safe procedure when rigid bronchoscopy is not available.


Subject(s)
Bronchoscopy , Device Removal , Tracheostomy , Humans , Tracheostomy/adverse effects , Tracheostomy/instrumentation , Tracheostomy/methods , Device Removal/methods , Bronchoscopy/methods , Stents/adverse effects , Trachea/surgery , Male , Tracheal Stenosis/surgery , Tracheal Stenosis/therapy , Tracheal Stenosis/etiology , Female
3.
Eur Arch Otorhinolaryngol ; 281(6): 3061-3069, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38582815

ABSTRACT

BACKGROUND: Expiratory central airway collapse (ECAC) following postintubation airway stenosis (PITS) is a rare phenomenon. The impact of airway malacia and collapse on the prognosis and the success rate of bronchoscopic interventional therapy in patients with PITS had been inadequately investigated. OBJECTIVE: The aim of this research was to assess the influence of airway malacia and collapse on the efficacy of bronchoscopic interventional therapy in patients with PITS. DESIGN: This retrospective analysis examined the medical documentation of individuals diagnosed with PITS who underwent bronchoscopic intervention at the tertiary interventional pulmonology center of Emergency General Hospital from 2014 to 2021. MAIN OUTCOME MEASURES: Data pertaining to preoperative, perioperative, and postoperative stages were documented and subjected to analysis. RESULTS: The patients in malacia and collapse group (MC group) exhibited a higher frequency of perioperative complications, including intraoperative hypoxemia, need for reoperation within 24 h, and postoperative intensive care unit admission rate (P < 0.05, respectively). Meanwhile, patients in group MC demonstrated significantly worse postoperative scores (higher mMRC score and lower KPS score) compared to those in pure stenosis group (P < 0.05, respectively), along with higher degrees of stenosis after treatment and a lower success rate of bronchoscopic intervention therapy cured (P < 0.05, respectively). Pearson analysis results showed that these terms were all significantly correlated with the occurrence of airway malacia and collapse in the airway (P < 0.05, respectively). CONCLUSION: The presence of malacia or collapse in patients with PITS was associated with increased perioperative complications following bronchoscopic interventional therapy, and significantly reduced the long-term cure rate compared to patients with pure tracheal stenosis. Trial registration Chinese Clinical Trial Registry on 06/12/2021. REGISTRATION NUMBER: ChiCTR2100053991.


Subject(s)
Bronchoscopy , Intubation, Intratracheal , Tracheal Stenosis , Humans , Bronchoscopy/methods , Tracheal Stenosis/etiology , Tracheal Stenosis/surgery , Tracheal Stenosis/therapy , Male , Female , Retrospective Studies , Middle Aged , Intubation, Intratracheal/adverse effects , Adult , Aged , Postoperative Complications/etiology , Postoperative Complications/therapy , Treatment Outcome
4.
J Am Vet Med Assoc ; 262(7): 1-7, 2024 Jul 01.
Article in English | MEDLINE | ID: mdl-38569539

ABSTRACT

OBJECTIVE: To evaluate the efficacy, complications, and outcome of Dumon silicone stent placement for dogs with grade IV tracheal collapse. ANIMALS: 12 client-owned dogs. CLINICAL PRESENTATION: Each dog was diagnosed with grade IV TC unresponsive to medical therapy and had severe obstructive respiratory failure. RESULTS: 12 dogs were included in the study. By the end of the study, 5 of 12 (41.7%) remained alive, while 7 of 12 (58.3%) dogs died. Survival times after stent placement ranged from 97 to 1,310 days (mean, 822.43 days; median, 810 days). Three of the 12 (25%) dogs died spontaneously, while 4 of 12 (33.3%) were euthanized. The cause of death was determined for 6 of 7 (85.7%) dogs and was TC related for 3 of 7 (50%). Causes of death related to TC were progressive airway collapse (2/3 [66.6%]) and incoercible cough (1/3 [33.4%]). Complications occurred in 9 of 12 (75%) cases and included granulation tissue growth (3/12 [25%]), incoercible cough (2/12 [16.7%]), stent migration (1/12 [8.3%]), and stent deformation (1/12 [8.3%]). Reduction of obstructive dyspnea and episodes of asphyxiation was achieved after Dumon silicone stent placement. CLINICAL RELEVANCE: The placement of an intraluminal Dumon silicone stent was a successful salvage treatment for TC in dogs that did not respond to medical management. Disease progression is inevitable, but substantial improvement of respiratory function may be achieved for months to years.


Subject(s)
Dog Diseases , Stents , Animals , Dogs , Stents/veterinary , Dog Diseases/therapy , Dog Diseases/surgery , Male , Female , Silicones , Treatment Outcome , Tracheal Stenosis/veterinary , Tracheal Stenosis/surgery , Tracheal Stenosis/therapy , Retrospective Studies
8.
Arch. bronconeumol. (Ed. impr.) ; 56(10): 643-650, oct. 2020. tab, graf, ilus
Article in Spanish | IBECS | ID: ibc-201517

ABSTRACT

INTRODUCCIÓN: El objetivo de este estudio es evaluar la reactividad traqueal inducida por un stent traqueal biodegradable de polidioxanona. MATERIAL Y MÉTODOS: Veintidós conejos se dividieron en 3 grupos con diferentes tiempos de supervivencia (30, 60 y 90 días postimplantación). Se implantó un stent biodegradable en cada animal, excepto en uno de cada grupo (control negativo). La implantación se realizó a través de una pequeña traqueotomía y bajo control fluoroscópico. Al finalizar los tiempos de supervivencia programados se realizaron estudios de TC y anatomopatológicos. RESULTADOS: Ningún animal murió durante el procedimiento ni en el seguimiento. El stent había desaparecido en el 100% de los casos a los 90 días, en el 50% a los 60 días y en ninguno a los 30 días. En los estudios de TC se observó un grosor de la pared traqueal mayor a los 30 que a los 60 y 90 días (1,60 ± 0,41 mm en la parte central del stent frente a 1,11 ± 0,18 y 0,94 ± 0,11; p = 0,007). En el estudio anatomopatológico no se encontraron granulomas. A los 30 días se observaba cierto grado de alteración histológica, la cual se reduce a los 60 y 90 días. También se encuentran las diferencias, tanto en las TC como en la histología, entre animales con el stent presente y animales con el stent degradado. CONCLUSIONES: Los stents de polidioxanona producen una leve reacción traqueal que revierte con la degradación. El uso de estos stents biodegradables en la patología traqueal benigna es prometedor


INTRODUCTION: The objective of this study was to evaluate tracheal reactivity induced by a biodegradable polydioxanone tracheal stent. MATERIALS AND METHODS: Twenty-two rabbits were divided into 3 groups assigned to different survival times (30, 60 and 90 days post-implantation). A biodegradable stent was implanted in each animal, except for 1 of each group (negative control). Implantation was performed through a small tracheotomy under fluoroscopic control. CT and histopathological studies were scheduled at the end of survival times. RESULTS: No animal died during the procedure or follow-up. The stent had disappeared in 100% of the cases at 90 days, in 50% at 60 days, and in none at 30 days. CT studies revealed a greater tracheal wall thickness at 30 days than at 60 and 90 days (1.60 ± 0.41 mm in the central part of the stent versus 1.11 ± 0.18 and 0.94 ± 0.11; P = .007, respectively). No granulomas were observed on histopathology. Some degree of histological changes were noted at 30 days, which had reduced at 60 and 90 days. Differences were also found in both CT and histology between animals in which the stent was present and animals in which it had degraded. CONCLUSIONS: Polydioxanone stents produce a mild reaction that reverts with tracheal degradation. The use of these biodegradable stents in benign tracheal disease is promising


Subject(s)
Animals , Rabbits , Absorbable Implants/veterinary , Biocompatible Materials , Polydioxanone/therapeutic use , Stents , Tracheal Stenosis/therapy , Tracheal Stenosis/veterinary , Models, Animal , Tomography, X-Ray Computed/veterinary , Fluoroscopy/methods
9.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 112-124, Jan.-Mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090547

ABSTRACT

Abstract Introduction Mitomycin C is a natural antibiotic that has been used to inhibit the proliferation of fibroblasts in scar tissue. Objective To evaluate the effectiveness and safety of topical Mitomycin C as an adjuvant in the endoscopic treatment of laryngotracheal stenoses. Data synthesis A systematic review of experimental or observational studies that have evaluated the treatment of laryngotracheal stenoses with the use of topical Mitomycin C was performed. Databases researched: LILACS, PubMed, Embase, Cochrane and Web of Science. Outcomes: resolution (symptom-free time ≥ one year), number of procedures required, and complications resulting from the procedure. A total of 15 studies (involving 387 patients) were selected. Mitomycin C was administered to every patient in 11 studies, and in 4 other studies, the patients were separated into 2 groups, 1 receiving mitomycin C, and the other not. The resolution of the stenosis evaluated in 12 studies in which the patients received mitomycin C was of 69% (95% confidence interval [95%CI]: 61-76%; I2 = 17.3%). A total of 52% of the patients (95%CI: 39-64%, 11 studies; I2 = 64.7%) were submitted to a single endoscopic procedure, and 48% (95%CI: 36-61%, 11 studies; I2 = 64.7%) were submitted to more than 1 procedure. Complications (mediastinal and subcutaneous emphysema, dysphonia, laceration or vocal fold paralysis and acute light obstruction) were reported in 9% of the patients (95%CI: 3-18%, 9 studies; I2 = 79.8%). Conclusions The evidence suggests that mitomycin C is an effective and safe option in the endoscopic treatment of laryngotracheal stenosis.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Tracheal Stenosis/therapy , Laryngostenosis/therapy , Mitomycin/therapeutic use , Laryngoscopy/methods , Administration, Topical , Treatment Outcome , Mitomycin/administration & dosage , Combined Modality Therapy
10.
Arch. argent. pediatr ; 118(1): e72-e76, 2020-02-00. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1096164

ABSTRACT

La estenosis traqueal adquirida es muy poco frecuente en la edad pediátrica y puede responder a múltiples causas; la estenosis posintubación y la secundaria a traqueotomía son las más comunes.El manejo de la estenosis traqueal adquirida sigue siendo controvertido. El tratamiento endoscópico proporciona el alivio inmediato de los síntomas, pero se asocia a una alta tasa de recurrencia, y el uso de prótesis endoluminales puede incrementar la longitud de la estenosis y complicar una cirugía futura. Por el contrario, se han documentado buenos resultados a largo plazo con la resección traqueal con anastomosis primaria.Se describe nuestra experiencia con la resección traqueal con anastomosis término-terminal para el tratamiento de la estenosis traqueal posintubación en 8 pacientes.


Acquired tracheal stenosis is a very infrequent lesion in the pediatric age group and may be due to diverse causes, being post-intubation stenosis and stenosis secondary to tracheostomy the most common ones.The management of acquired tracheal stenosis remains controversial. Endoscopic treatment provides immediate relief of symptoms but it is associated with a high recurrence rate, and the use of endoluminal prostheses can increase the length of the stricture complicating future surgery. Conversely, good long-term results have been documented with tracheal resection and primary anastomosis.We describe our experience with tracheal resection followed by end-to-end anastomosis for the treatment of post-intubation tracheal stenosis in 8 patients.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Tracheal Stenosis/surgery , Tracheal Stenosis/therapy , Endoscopy , Intubation, Intratracheal/adverse effects
11.
Rev. otorrinolaringol. cir. cabeza cuello ; 79(3): 271-278, set. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058697

ABSTRACT

RESUMEN Introducción: La estenosis subglótica adquirida es una causa importante de estridor persistente después de una intubación endotraqueal. El diagnóstico y manejo tempranos pueden llevar a procedimientos menos invasivos con altas tasas de éxito. Si las lesiones agudas posintubación evolucionan hacia una estenosis, las dilataciones endoscópicas usando instrumentos romos o balones podrían lograr restablecer un lumen adecuado. Los balones son efectivos, pero caros y obstruyen la vía respiratoria al momento de la dilatación. Objetivo: Presentar nuestra experiencia con la dilatación progresiva de estenosis subglótica adquirida posintubación utilizando tubos endotraqueales. Material y método: Revisión retrospectiva de las dilataciones realizadas como tratamiento primario en estenosis subglótica pediátrica adquirida. Resultados: Se incluyeron 16 pacientes con estenosis de grados I a III, con una edad promedio de 2 años y 4 meses. El tiempo promedio de intubación fue de 6,6 días. El número de procedimientos promedio fue de 2, con un rango de 1 a 6. El éxito clínico se logró en todos los pacientes, con resolución de los síntomas respiratorios y evitando la traqueostomía. No hubo complicaciones ni mortalidad asociadas. Conclusión: En esta cohorte, la dilatación subglótica con tubos endotraqueales fue eficaz y segura. Estos están ampliamente disponibles y permiten ventilar al paciente mientras se realiza el procedimiento.


ABSTRACT Introduction: Acquired post-intubation subglottic stenosis is one of the most important complications causing persistent stridor after endotracheal intubation. Early diagnosis and management can lead to less-invasive procedures with high success rates. If the acute post-intubation injuries progress into a stenosis, endoscopic dilatations can be attempted to reestablish an adequate lumen. These can be performed using blunt instrument or balloons. Balloons are effective but expensive, and obstruct the airway while dilatating. Aim: Present our experience with progressive blunt dilatation of acquired post-intubation subglottic stenosis using endotracheal tubes. Material and method: Retrospective chart review of dilatations performed as the primary treatment in early acquired pediatric subglottic stenosis. Results: 16 patients with grades I to III stenosis were included. Average age was 2 years 4 months, and average intubation time was 6.6 days. The number of procedures ranged between 1 and 6, with a mean of 2. Clinical success was achieved in all patients, with resolution of respiratory symptoms and avoidance of tracheostomy. There were no complications or mortality. Conclusion: In this cohort, subglottic dilatation using endotracheal tubes was effective and safe. Endotracheal tubes are easily available and allow to ventilate the patient while performing the procedure.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Tracheal Stenosis/therapy , Laryngostenosis/therapy , Intubation, Intratracheal/methods , Time Factors , Tracheal Stenosis/pathology , Severity of Illness Index , Laryngostenosis/pathology , Retrospective Studies , Treatment Outcome , Dilatation
13.
Cir. pediátr ; 31(1): 8-14, ene. 2018. ilus, graf, tab
Article in Spanish | IBECS | ID: ibc-170524

ABSTRACT

Introducción y objetivo. La estenosis adquirida de la vía aérea es una complicación frecuente tras la intubación endotraqueal. La dilatación endoscópica ha sido aceptada como tratamiento de elección en los casos detectados de forma precoz. Nuestro objetivo es conocer el estado actual de los pacientes tratados en nuestro centro mediante dilatación endoscópica en los últimos 10 años. Material y métodos. Estudio de cohorte retrospectivo de pacientes con estenosis subglóticas y traqueales adquiridas (ESTA) tratadas endoscópicamente mediante dilatación con balón en nuestro centro en los últimos 10 años. Se realizaron broncoscopias de control a las 2 semanas, al mes, a los 3 y 6 meses postdilatación y posteriormente en función de la clínica. Resultados. Se trataron 32 pacientes de ESTA de reciente aparición en dicho periodo. La mediana de edad fue de 4,5 (3-120) meses. Fueron necesarias 2,5 (1-5) dilataciones por paciente. Todos los pacientes fueron extubados en quirófano o en las 24 horas siguientes al procedimiento. No hubo complicaciones durante los procedimientos ni durante el postoperatorio. El tiempo de seguimiento fue de 6 (1-10) años. Solo 1 de los 32 pacientes presentó recidiva de la estenosis 2 años después que fue secundaria a reintubaciones por nuevas intervenciones quirúrgicas; la cual se dilató nuevamente. Conclusión. La dilatación endoscópica precoz en las estenosis adquiridas de la vía aérea es un procedimiento seguro y eficaz a largo plazo. Los resultados avalan el uso de esta técnica como tratamiento de elección en estos pacientes (AU)


Introduction. Acquired stenosis of the airway is a common complication after endotracheal intubation. Endoscopic dilation has been accepted as the treatment of choice in cases detected precociously. Our goal is to know the current status of the patients treated in our hospital with endoscopic dilation in the last 10 years Material and methods. Retrospective cohort study of patients with subglottic and tracheal acquired stenosis (STAS) early treated endoscopically with balloon dilation at our center in the last 10 years. Bronchoscopy control at 2 weeks, a month, 3 and 6 months post-dilation were performed and later on depending on the symptoms. Results. 32 patient were treated in the period considered. The median age was 4.5 (3-120) months. There were necessary 2.5 (1-5) dilations per patient. All cases were extubated in the operating room or in the following 24 hours. There were no complications during the procedure. Follow-up time was 6 (1-10) years. Only 1 of the 32 patients have had recurrence of stenosis 2 years after, it was secondary to reintubations due to new surgical interventions; which it was dilated successfully. Conclusions. Early endoscopic dilation in the acquired airway stenosis is a safe and effective long-term procedure. The results support the use of this technique as a treatment of choice in these patients (AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Long-Term Care/methods , Tracheal Stenosis/diagnostic imaging , Tracheal Stenosis/therapy , Bronchoscopy/methods , Glottis/diagnostic imaging , Glottis/physiopathology , Retrospective Studies , Endoscopy
16.
Rev. méd. Chile ; 142(3): 382-385, mar. 2014. ilus
Article in Spanish | LILACS | ID: lil-714363

ABSTRACT

Granulomatosis with polyangiitis (GPA) or Wegener's disease is characterized by a granulomatous vasculitis of the upper and lower airways and kidney. It involves the lower respiratory tract causing subglottic tracheal stenosis, which occurs in approximately 22% of patients. We report two females aged 40 and 52 years, admitted to the hospital with a subglottic tracheal stenosis. Their symptoms and management are reviewed. The frst patient responded to rituximab. The second patient required a tracheostomy.


Subject(s)
Adult , Female , Humans , Middle Aged , Granulomatosis with Polyangiitis/complications , Tracheal Stenosis/etiology , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Tracheal Stenosis/therapy , Tracheostomy
17.
Pulmäo RJ ; 23(2): 32-36, 2014.
Article in Portuguese | LILACS | ID: lil-727913

ABSTRACT

A extensa rede vascular pulmonar e brônquica, associada à grande quantidade de células imunocompetentes, torna os pulmões importante alvo de vasculites imunomediadas. O envolvimento destes vasos sanguíneos pode provocar qualquer sintoma respiratório, dependendo do tipo, local e extensão da lesão no sistema vascular respiratório. Algumas situações ameaçadoras da vida podem resultar, abrindo ou acompanhando o quadro destas patologias e, se não prontamente identificadas e tratadas, podem resultar em risco elevado de morbimortalidade. Destacamos duas destas condições especiais - estenoses de grande vias aéreas e hemorragia alveolar disusa - e descrevemos seus aspectos fisiopatológicos, clínicos e terapêuticos


The extensive pulmonary and bronchial vascular system, associated to large amount of immunocompetent cells, makes the respiratory system an important target of immune mediated vasculitis. These blood vessels involvement can cause any respiratory symptoms, depending on the type, location, and degree of lesion in the pulmonary vascular system. Some life-thereatening conditions may ensue, opening or following the course of those deseases and, if not identified and treated promptly, result in increased risk of morbitidy and mortality. We highlight two of those special situations: large airway stenosis and diffuse alveolar hemorrhage, describing their pathophysiological clinical and therapeutic aspects


Subject(s)
Humans , Male , Female , Tracheal Stenosis/physiopathology , Tracheal Stenosis/therapy , Vasculitis/diagnosis , Vasculitis/physiopathology , Vasculitis/therapy , Lung Diseases
18.
Rev. cuba. cir ; 51(4): 318-325, oct.-dic. 2012.
Article in Spanish | LILACS | ID: lil-662288

ABSTRACT

Introducción: la estenosis traqueal corresponde a una complicación común, secundaria a la intubación o a la traqueotomía. Existen varias modalidades en cuanto a su tratamiento, por eso nos propusimos evaluar los resultados del tratamiento de la estenosis traqueal isquémica mediante fotorresección con Nd-YAG láser. Métodos: se realizó un estudio prospectivo descriptivo en 160 pacientes, con estenosis traqueal isquémica operados en el Servicio de Otorrinolaringología del Centro de Investigaciones Médico-Quirúrgicas, en el período comprendido de enero de 1987 hasta diciembre del 2010. Se clasificó a las estenosis traqueales postintubación, en 5 grupos, según Luis Rocabado y otros. El método diagnóstico empleado fue la broncoscopia. Los pacientes admitidos en el estudio tenían traqueotomía y fueron clasificados en grupo I y II. Como proceder quirúrgico se realizó fotorresección con Nd-YAG láser y colocación de cánula en T de Montgomery. Los enfermos se valoraron clínica y endoscópicamente al alta y posteriormente en consulta externa durante un período de 1 año. Resultados: el mayor porciento de los pacientes corresponde al sexo femenino. El rango de edad fue entre los 30 y 49 años con una desviación estándar de 36,7 ± 5,0 años. Se clasificaron 93 (58,1 por ciento) pacientes en el grupo I y 67 (41,9 por ciento) en el grupo II. La causa más frecuente de intubación endotraqueal prolongada, fue el politrauma. Se complicaron 13 pacientes, con una mortalidad de 2,5 por ciento. El resultado final se evaluó como bueno en 94 pacientes (58,7 por ciento), satisfactorio en 53 (33,2 por ciento) y malo en 9 (5,6 por ciento). Conclusiones: el tratamiento inicial para las estenosis traqueales isquémicas clasificadas como grado I y II debe ser por vía endoscópica con Nd-YAG láser(AU)


Introduction: Tracheal stenosis is a common complication secondary to intubation or to tracheostomy. There are several treatment modalities to face this problem, hence we suggested that the results of the treatment of ischemic tracheal stenosis be evaluated based on photoresection with Nd-YAG laser. Methods: A prospective descriptive study was performed in 160 patients, who suffered ischemic tracheal stenosis and had been operated on at the Otolaryngology Service of the Medical and Surgical Research Center (CIMEQ) in the period from January 1987 to December 2010. Post-intubation tracheal stenosis was classified in five groups, according to Luis Rocabado et al.'s classification. The diagnosing method was bronchoscopy. All the patients included in the study had tracheotomy and were classified into the group I and group II. The surgical procedure performed on patients was photoresection with Nd Yag laser and placement of Montgomery's T- stent. The patients were clinically and endoscopically evaluated at discharge and afterwards at the outpatient service for one year. Results: The highest percentage of patients was females. The age range was 30 to 49 years, with SD= 36.7 ± 5. 0 years. Ninety three (58.1 percent) were classified in group I whereas 67 (41.9 percent) were included in group II. The most frequent cause in extended endotracheal intubation was multiple trauma. Thirteen patients suffered complications; the mortality rate was 2.5 percent. The final result was evaluated as good in 94 (58.7 percent), satisfactory in 53 (33.2 percent) and negative in 9 (5.6 percent) patients. Conclusions: The initial treatment for ischemic tracheal stenoses classified as grade I and II should be endoscopic by using Nd-YAG laser(AU)


Subject(s)
Humans , Female , Adult , Tracheal Stenosis/therapy , Tracheotomy/methods , Lasers, Solid-State/therapeutic use , Bronchoscopy/adverse effects , Epidemiology, Descriptive , Prospective Studies
19.
Yonsei Medical Journal ; : 565-570, 2012.
Article in English | WPRIM (Western Pacific) | ID: wpr-190364

ABSTRACT

PURPOSE: Stenting has been developed to deal with airway stenosis and is applicable in patients with post-intubation tracheal stenosis (PITS) in whom surgery would not be indicated. The purpose of this study was to investigate the prognostic factors in inoperable patients in whom a silicone stent was inserted due to PITS. MATERIALS AND METHODS: We retrospectively evaluated 55 PITS patients undergoing silicone stenting between January 2001 and December 2009. RESULTS: Silicone stent was inserted to narrowed trachea after the combination of pre-dilatation including laser cauterization, mechanical bougienation and ballooning. Following airway stabilization, the stent could be removed successfully in 40% (22/55) of the patients after median 12 months of stenting. However, in 60% (33/55) of patients, the stent could not be removed successfully and surgical management was needed after initial stabilization. Multivariate analysis revealed that the stent could be successfully removed more frequently in those who do not have cardiovascular disease [odds ratio (OR)=12.195; p=0.036] and the intervention was performed within 6 months after intubation (OR=13.029; p=0.031). CONCLUSION: Among those patients undergoing silicone stenting due to PITS, the stent could be successfully removed when patients do not have cardiovascular disease and stented within 6 months after intubation.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Bronchoscopy , Intubation, Intratracheal/instrumentation , Retrospective Studies , Stents , Tracheal Stenosis/therapy
20.
Rev. esp. patol. torac ; 23(4): 317-319, oct.-dic. 2011. ilus
Article in Spanish | IBECS | ID: ibc-104709

ABSTRACT

La obstrucción maligna de la tráquea y de ambos bronquios principales es una condición poco frecuente en pacientes con cáncer de pulmón. En algunos casos no es posible garantizar la ventilación pulmonar (..) (AU)


Malignant obstruction of the trachea and both main bronchi is a rare condition in patients with lung cancer. In some cases, it is not possible to ensure bilateral lung ventilation, but (..) (AU)


Subject(s)
Humans , Male , Middle Aged , Airway Obstruction/therapy , Catheterization/methods , Endoscopy , Tracheal Stenosis/therapy , Lung Neoplasms/complications
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