Postintubation Multisegmental Tracheal Stenosis: A 24-Year Experience
| Autor: | R Farzanegan, Seyed Reza Saghebi, Kambiz Sheikhy, Sina Nazemy, N Jahanshahi, Abolghasem Daneshvarkakhki, Mohammad Behgam Shadmehr, Mahdi Zangi, Saviz Pejhan, Farahnaz Sadeghbeigee, Azizollah Abbasidezfouli |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Adolescent medicine.medical_treatment Tracheal surgery Iatrogenic Disease 030204 cardiovascular system & hematology 03 medical and health sciences Postoperative Complications Tracheostomy 0302 clinical medicine Bronchoscopy Intubation Intratracheal medicine Mucositis Iatrogenic disease Humans Intubation Child Tracheal infection Retrospective Studies Univariate analysis business.industry Middle Aged medicine.disease Combined Modality Therapy Surgery Tracheal Stenosis Trachea 030228 respiratory system Child Preschool Female Stents Cardiology and Cardiovascular Medicine Airway business |
| Zdroj: | The Annals of Thoracic Surgery. 112:1101-1108 |
| ISSN: | 0003-4975 |
| Popis: | Background Management of multisegmental tracheal stenosis is challenging. In this 24-year longitudinal single-center study, we present an algorithmic treatment approach. Methods A retrospective analysis of 2167 patients with postintubation tracheal stenosis indicated 83 (3.83%) patients with multisegmental tracheal stenosis. Patients were assigned to 4 management groups according to the length, location, and severity of stenoses; tracheal infection/mucositis; laryngeal function; symptoms; general condition; and comorbid diseases. Type 1 (n = 13): 1-stage resection of both strictures, Type 2 (n = 6): 2-stage resection of both strictures, Type 3 (n = 40): resection of 1 stricture and nonresectional management of the other, Type 4 (n = 24): nonresectional management of both strictures. Outcomes were categorized as Good, Acceptable, or Poor. Univariate analyses for factors predictive of recurrence and outcome were performed. Results Follow-ups were completed in 70 (84.34%) patients (median, 22.5 months). Outcome was assessed as Good in 56 (82.35%), Acceptable in 10 (14.71%), Poor in 2 (2.94%), and mortality in 2 (2.94%) patients. The median length of airway resection was 46, 67.5, and 40 mm in Types 1-3, respectively. Only 11 (13.25%) patients had no history of tracheostomy or tracheal surgery. By univariate analysis, a shorter intubation period was associated with Good outcome (P = .017). No factors predictive of recurrence or outcome were ascertained. Conclusions Multisegmental tracheal stenosis, generally caused by performing an inappropriate tracheostomy, is an iatrogenic disease that can be prevented. Although resection of both strictures may be feasible and is associated with Good results, in the majority of cases, a combination of surgical resection and non-resectional methods are sufficient to achieve Good results. |
| Databáze: | OpenAIRE |
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