Hosna Asma, Haseeb Ul Rasool Muhammad, Noff Nicole C, Makhoul Karim, Miller Daniel, Umar Zaryab, Ghallab Muhammad, Hasan Rockyb, Ashfaq Salman, Parikh Avish, Lopez Ricardo
Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA.
Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA.
Cureus. 2023 Jun 26;15(6):e41012. doi: 10.7759/cureus.41012. eCollection 2023 Jun.
Tracheal stenosis (TS) is an iatrogenic sequela after intubation or tracheostomy that is increasing despite technological improvement and skilled respiratory care in the ICU. According to the studies, the rate of TS varies from 10 to 22%, but only 1-2% of these stenoses are severe and present with inspiratory dyspnea that does not respond to medical management. Bronchoscopy is considered the most appropriate diagnostic test, and laser surgery and tracheobronchial stenting are the most commonly performed procedures for tracheal stenosis. However, alternative treatment options, including cryotherapy for inoperable patients, have yet to be studied widely. As the number of patients requiring ICU admission with mechanical intubation is increasing, it is crucial to acknowledge this complication and consider alternative management options. Here we present a review of the use of cryotherapy for post-intubation tracheal stenosis. Pubmed, Cochrane, and EMBASE databases were inquired for studies performed using the keywords 'airway stricture' OR 'airway obstruction' AND 'post-intubation' OR 'post-extubation' OR 'tracheostomy' AND 'cryotherapy'. After the primary and secondary screening, five studies were included in the analysis. We included 67 patients were included in the analysis, with a mean age of 50.2 (range: 42-55) years. Tracheal stenosis and subglottic stricture were the most common sites of stenosis. Twenty-nine patients were treated with cryotherapy only, while the rest 38 patients had cryotherapy followed by balloon dilation. After the intervention, 48 patients experienced improvement, five experienced no change in the symptoms, 13 patients were asymptomatic before the treatment, and one died. No complication was reported in 65 patients, with only minor complications reported in rest. Although, there is no clear treatment protocol for patients with inoperable tracheal stenosis. Our review demonstrates that cryotherapy for inoperable tracheal stenosis can be an acceptable alternative treatment with significant clinical improvement. Additionally, cryotherapy has fewer adverse effects compared to other treatment options.
气管狭窄（TS）是插管或气管切开术后的医源性后遗症，尽管重症监护病房（ICU）的技术有所进步且呼吸护理水平较高，但气管狭窄的发生率仍在上升。根据研究，气管狭窄的发生率在10%至22%之间，但其中只有1%至2%的狭窄较为严重，表现为吸气性呼吸困难，且药物治疗无效。支气管镜检查被认为是最合适的诊断方法，激光手术和气管支气管支架置入术是治疗气管狭窄最常用的方法。然而，包括针对无法手术的患者进行冷冻治疗在内的其他治疗选择尚未得到广泛研究。随着需要机械通气并入住ICU的患者数量不断增加，认识到这一并发症并考虑其他管理方案至关重要。在此，我们对冷冻治疗在插管后气管狭窄中的应用进行综述。我们在PubMed、Cochrane和EMBASE数据库中检索了使用关键词“气道狭窄”或“气道阻塞”以及“插管后”或“拔管后”或“气管切开术”以及“冷冻治疗”进行的研究。经过初步和二次筛选，五项研究被纳入分析。我们纳入了67例患者进行分析，平均年龄为50.2岁（范围：42至55岁）。气管狭窄和声门下狭窄是最常见的狭窄部位。29例患者仅接受了冷冻治疗，其余38例患者在冷冻治疗后进行了球囊扩张。干预后，48例患者症状改善，5例患者症状无变化，13例患者治疗前无症状，1例死亡。65例患者未报告并发症，其余患者仅报告了轻微并发症。尽管对于无法手术的气管狭窄患者尚无明确的治疗方案。我们的综述表明，冷冻治疗对于无法手术的气管狭窄是一种可接受的替代治疗方法，具有显著的临床改善效果。此外，与其他治疗选择相比，冷冻治疗的不良反应较少。
