Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
School of Medicine, University of Maryland, Baltimore, Maryland, USA.
Otolaryngol Head Neck Surg. 2021 Jun;164(6):1265-1271. doi: 10.1177/0194599820978276. Epub 2020 Dec 8.
Predictors of tracheostomy decannulation in patients with laryngotracheal stenosis are not fully known, making prognosis difficult. The aim was to identify predictors of tracheostomy decannulation in adult patients with acquired stenosis of the larynx and/or trachea who were tracheostomy dependent.
Case series.
Academic teaching hospital.
A total of 103 consecutive adult patients with laryngotracheal stenosis who were tracheostomy dependent and seen by the otolaryngology clinic from January 1, 2013, to August 2, 2018, were included. Exclusion criteria included age <18 years, history of laryngeal cancer or head and neck radiation, or history of laryngeal fracture. The primary outcome was the presence of tracheostomy at last follow-up. The patients' etiology of stenosis, comorbid conditions, and characteristics of the stenosis were analyzed to determine if there was a statistically significant relationship with decannulation.
A total of 103 patients were included: 67% of patients were women and the average age was 53.5 years. Sixty-four patients (62%) were successfully decannulated. In multivariate analysis, patients who were successfully decannulated presented to the otolaryngology clinic earlier after tracheostomy was performed, were more likely to have been intubated due to trauma, and were less likely to have gastroesophageal reflux disease. In patients with subglottic or tracheal stenosis, those with granulation tissue without firm scar were more likely to be decannulated, and those who underwent rigid dilation were less likely to be decannulated.
Early evaluation by an otolaryngologist may increase the likelihood of tracheostomy decannulation in patients with laryngotracheal stenosis. Patient comorbidities may assist in predicting which patients will be successfully decannulated.
喉气管狭窄患者行气管切开拔管的预测因素尚不完全清楚，导致预后困难。本研究旨在确定依赖气管切开术的成人获得性喉和/或气管狭窄患者行气管切开拔管的预测因素。
病例系列。
学术教学医院。
纳入了 2013 年 1 月 1 日至 2018 年 8 月 2 日期间因喉气管狭窄而依赖气管切开术并在耳鼻喉科诊所就诊的 103 例连续成年患者。排除标准包括年龄<18 岁、喉癌或头颈部放疗史或喉骨折史。主要结局为最后一次随访时是否存在气管切开。分析了患者狭窄的病因、合并症和狭窄的特征，以确定与拔管是否存在统计学显著关系。
共纳入 103 例患者：67%的患者为女性，平均年龄为 53.5 岁。64 例（62%）患者成功拔管。多变量分析显示，成功拔管的患者在气管切开后更早地到耳鼻喉科就诊，更可能因创伤而插管，且更可能没有胃食管反流病。在声门下或气管狭窄的患者中，那些有肉芽组织而无坚实瘢痕的患者更可能拔管，而那些接受硬性扩张的患者则更不可能拔管。
耳鼻喉科医生的早期评估可能增加喉气管狭窄患者行气管切开拔管的可能性。患者的合并症可能有助于预测哪些患者将成功拔管。
