Alaga Arvindran, Simhan Vineet, Lokeshwaran Srivatsa, Kumar K Sunil, Chetana Shanmukhappa Sanjana
Pulmonology Department Hospital Sultanah Bahiyah Alor Setar Malaysia.
Aster Whitefield Hospital Bangalore India.
Respirol Case Rep. 2024 Sep 8;12(9):e70014. doi: 10.1002/rcr2.70014. eCollection 2024 Sep.
Tracheal stenosis is a common complication of endotracheal intubation or tracheostomy, resulting in significant morbidity and mortality. Bronchoscope interventions have been proposed as a safe alternative for the management of post-intubation post-intubation tracheal stenosis (PITS). Data for patients diagnosed with PITS across two hospitals, between 2021 and 2022, encompassing demographic, clinical, and procedural details were gathered from electronic medical records, and analysed. Primary outcomes centred on assessing the incidence and severity of PITS through bronchoscope examination and radiological imaging, and the efficacy of bronchoscope interventions, including stenting and the application of mitomycin C. Twelve patients were managed for PITS. Majority of patients were females (9/12) with mean age of 46.41 years. Presenting signs and symptoms were dyspnea, rhonchi and failed extubation, the mean duration of intubation/ tracheostomy is 16.41 days (range: 3-40 days). Most common comorbidity was type 2 diabetes, (5 patients, 41.6%). The lesions mean length was 3.09 cm and Cotton-Meyer Grade II and III. Prompt evaluation is crucial, in these patients. The Cotton-Meyer grade is pivotal in treatment decisions, with intubating times correlating with the severity of stenotic disease. Our case series demonstrates the increasing utility of bronchoscopy in managing these cases.
气管狭窄是气管插管或气管切开术的常见并发症,会导致显著的发病率和死亡率。支气管镜介入已被提议作为治疗插管后气管狭窄(PITS)的一种安全替代方法。收集了2021年至2022年期间两家医院诊断为PITS的患者的数据,包括人口统计学、临床和手术细节,并进行了分析。主要结果集中在通过支气管镜检查和放射影像学评估PITS的发生率和严重程度,以及支气管镜介入的疗效,包括支架置入和丝裂霉素C的应用。12例患者接受了PITS治疗。大多数患者为女性(9/12),平均年龄为46.41岁。主要症状和体征为呼吸困难、哮鸣音和拔管失败,插管/气管切开的平均持续时间为16.41天(范围:3 - 40天)。最常见的合并症是2型糖尿病(5例,41.6%)。病变平均长度为3.09厘米,Cotton - Meyer分级为II级和III级。对这些患者进行及时评估至关重要。Cotton - Meyer分级在治疗决策中起关键作用,插管时间与狭窄疾病的严重程度相关。我们的病例系列证明了支气管镜检查在处理这些病例中的作用日益增加。