Parpucu Umit Murat, Aydemir Semih
Anesthesiology and Reanimation, Gulhane Faculty of Medicine - University of Health Sciences, Ankara, TUR.
Anesthesiology and Reanimation, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Ankara, TUR.
Cureus. 2023 Sep 26;15(9):e45978. doi: 10.7759/cureus.45978. eCollection 2023 Sep.
Background and objective The clinical course in patients with tracheal stenosis (TS) ranges from being asymptomatic to respiratory failure requiring follow-up in the ICU. In this study, we aimed to assess the clinical characteristics, management, and outcome of TS patients who were admitted to the ICU. Materials and methods The data of patients hospitalized in the ICU due to TS between January 01, 2015, and January 01, 2016, were analyzed. The patients were classified into two groups: the post-intubation tracheal stenosis (PITS) group and the post-tracheostomy tracheal stenosis (PTTS) group. Demographic characteristics, body mass index (BMI), the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the Sequential Organ Failure Assessment (SOFA) score of patients, factors that caused TS, management of TS, and ICU data of patients were compared. The outcome measures of our study were the ICU management of patients diagnosed with PITS or PTTS, their clinical characteristics, and differences in the treatment between patients diagnosed with PITS and those with PTTS in the ICU. Results Fifteen (75%) patients had PITS and five (25%) had PTTS. While BMI was significantly lower in patients in the PTTS group, the APACHE II and SOFA scores were significantly higher in PTTS patients (p<0.05). In most of the patients in the PITS group, the location of the stenosis was subglottic and at the 1/3 upper part of the trachea, while in the PTTS group, it was located only at the upper 1/3 of the trachea (p>0.05). Mechanical dilatation was performed in all patients in both groups. Mechanical dilatation and cryotherapy were performed in 10 (66.7%) patients in the PITS group (p>0.05), and a stent was applied in addition to this treatment in three (20%) patients in the PITS group and four (80%) patients in the PTTS group (p<0.05). Mechanical ventilation was not needed in 10 (66.7%) PITS patients and three (60.0%) PTTS patients after the interventional procedure. All patients were eventually discharged from the ICU after treatment. Conclusion While higher BMI was common in PITS patients, the PTTS patients were generally in worse condition. In this patient group, interventional pulmonology procedures in the ICU can be life-saving.
背景与目的 气管狭窄（TS）患者的临床病程范围从无症状到呼吸衰竭，需要在重症监护病房（ICU）进行随访。在本研究中，我们旨在评估入住ICU的TS患者的临床特征、治疗及预后。材料与方法 分析2015年1月1日至2016年1月1日因TS入住ICU的患者数据。患者分为两组：插管后气管狭窄（PITS）组和气管切开术后气管狭窄（PTTS）组。比较患者的人口统计学特征、体重指数（BMI）、急性生理与慢性健康状况评分系统II（APACHE II）评分和序贯器官衰竭评估（SOFA）评分、导致TS的因素、TS的治疗以及患者的ICU数据。本研究的结局指标为诊断为PITS或PTTS患者的ICU治疗情况、其临床特征以及ICU中诊断为PITS和PTTS患者在治疗上的差异。结果 15例（75%）患者为PITS，5例（25%）为PTTS。PTTS组患者的BMI显著较低，而PTTS患者的APACHE II和SOFA评分显著较高（p<0.05）。PITS组大多数患者狭窄部位位于声门下及气管上1/3处，而PTTS组仅位于气管上1/3处（p>0.05）。两组所有患者均进行了机械扩张。PITS组10例（66.7%）患者进行了机械扩张和冷冻治疗（p>0.05），PITS组3例（20%）患者和PTTS组4例（80%）患者在此治疗基础上还应用了支架（p<0.05）。介入治疗后，10例（66.7%）PITS患者和3例（60.0%）PTTS患者无需机械通气。所有患者经治疗后最终均从ICU出院。结论 PITS患者中较高的BMI较为常见，而PTTS患者总体状况通常较差。在该患者群体中，ICU中的介入肺科手术可能挽救生命。
