Postintubation tracheal stenosis and endoscopic management
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Pneumon 2003;16(3):262-270
ABSTRACT. Postintubation tracheal stenosis is an iatrogenic complication that occurs in critically ill patients receiving mechanical ventilation. It is by far the commonest benign cause of tracheal stenosis with an estimated incidence of 1% among intubated patients. Following simple and concrete preventive measures should avert this severe and potentially fatal complication. High clinical suspicion is vital to promptly diagnosing this condition once it appears. Treatment of post intubation tracheal stenosis may be difficult due to usually poor patient health status at the time of diagnosis. Circumferential sleeve resection of trachea with end-to-end anastomosis remains the treatment of choice, although it is only applied in strictly selected patients by highly experienced surgeons and is related to serious complications and significant relapse rates. Bronchoscopic, non-surgical techniques applied by pneumonologists, including bronchoscopic or balloon dilatation, laser resection and stenting have been proposed as alternatives to open surgery and feature several advantages. Indeed, short, web like stenoses may be definitively cured by laser resection and gentle dilatation, while stents are helpful for splinting lengthy stenoses. In inoperable cases, silicone stents represent the only therapeutic alternative; they are also valuable as initial conservative treatment in view of prospective surgical correction, allowing time for preparing the patient. A multidisciplinary approach engaging pneumonologists, as well as thoracic and ORL surgeons is crucial for the best management of patients with postintubation tracheal stenosis. Pneumon 2003, 16(3):262-270.
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