Postintubation Tracheal Stenosis: Management and Results 1993 to 2017
| Autor: | Cameron D. Wright, Harald C. Ott, Douglas J. Mathisen, Ashok Muniappan, Michael Lanuti, Shuben Li, Henning A. Gaissert, Abraham D. Geller |
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| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Time Factors Adolescent medicine.medical_treatment 030204 cardiovascular system & hematology Anastomosis Dehiscence 03 medical and health sciences Young Adult 0302 clinical medicine Postoperative Complications medicine Intubation Intratracheal Intubation Humans Child Tracheostomy present Aged Retrospective Studies Aged 80 and over business.industry Operative mortality Infant Retrospective cohort study Middle Aged Thoracic Surgical Procedures Laryngotracheal resection Surgery Tracheal Stenosis Treatment Outcome 030228 respiratory system Child Preschool Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of thoracic surgery. 108(5) |
| ISSN: | 1552-6259 |
| Popis: | Background To evaluate the management, complications of treatment, and outcomes of postintubation tracheal stenosis. Methods A retrospective review was performed of records from a prospective database of all patients undergoing tracheal or laryngotracheal resection from 1993 to 2017 for postintubation tracheal stenosis. Redo operations after failure of initial resection and reconstruction for postintubation tracheal stenosis were included. Results There were 392 patients whose ages ranged from 3 months to more than 84 years. A tracheostomy was performed in 275 as part of their care before surgery (present at time of resection in 123), dilations in 201, laser treatment in 82, T tubes in 66, and stents in 44 patients. Median length of resection was 3 cm. Laryngeal release was required in 15 of 392 (3.8%). Operative mortality was 0.8% (3 of 392); T tubes, tracheostomy present at resection, requirement for postoperative tracheostomy, and laryngeal involvement adversely impacted outcomes. Patients having tracheal resection and reconstruction had good or satisfactory outcomes in 96% (289 of 301) compared with 85% (77 of 91) having laryngotracheal resection. Complications within 30 days and at more than 30 days occurred in 116 patients and 14 patients, respectively. There were 96 anastomotic complications—68% minor (65 of 96), and 32% major (31 of 96). Necrosis of cartilage occurred in 12 patients and dehiscence in 14 patients. Conclusions Despite advances in care postintubation tracheal stenosis remains a challenging problem. Laryngotracheal resection and tracheostomy lead to worse outcomes. Excellent surgical results can be obtained for postintubation tracheal stenosis. Good results require careful evaluation, management of comorbid conditions, meticulous technique, minimizing tension, and preservation of blood supply. |
| Databáze: | OpenAIRE |
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