Oesophageal Balloon Tracheoplasty in Early Tracheal Stenosis following Percutaneous Tracheostomy

Abstract Background Tracheal stenosis following prolonged intubation is a relatively rare but serious problem. This condition is usually managed by surgical or endoscopic interventions. Bronchoscopic balloon dilatation for tracheal stenosis is considered a valuable tool used for the management of tracheal stenosis. In this article, we try to evaluate the role of balloon tracheoplasty in the management of tracheal stenosis and to assess the number of dilatation sessions usually needed as well as the short to midterm outcome. Results This study involved 40 patients with tracheal stenosis diagnosed by computed tomography (neck and chest) and bronchoscopy at the Security Force Hospital in Riyadh, KSA, between January 2013 and August 2018. Patients’ data were retrospectively reviewed and analyzed. Patients’ age ranged between 18 and 60 years. Thirty patients were males (75%); those patients underwent balloon tracheoplasty via dilatation of areas of narrowing using catheter balloon insufflation guided by fiber-optic bronchoscope. Ninety-five percent of the patients had initial success with acceptable dilatation of the stenotic area and improvement of the symptoms. There were no technical or major problems which resulted from the procedure, and no patient complained of severe pain or severe discomfort after the procedure. From the total of 81 BBD sessions, no in-hospital mortality is related to the procedure itself, and ICU stay ranged between 1 and 5 days post-procedure. Among those 40 patients, 16 patients (40%) needed one session, 10 patients (25%) needed two sessions, 8 patients (20%) needed three sessions, and 6 patients (15%) needed more than three sessions of balloon dilatation. Conclusion Balloon tracheoplasty is a simple, safe method and could be a promising and effective approach that offers immediate symptomatic relief for tracheal stenosis in cases with a history of prolonged intubation. It is worth mentioning that BBD is considered as a temporary measure, and most of the cases will need definitive or additional treatment either resection or stent placement.

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Dilation of tracheal stenosis below tracheostomy tube with Dolphin percutaneous tracheostomy kit

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-020-01311-8 ◽

2020 ◽

Vol 68 (6) ◽

pp. 655-658 ◽

Cited By ~ 1

Author(s):

Alfonso Fiorelli ◽

Mary Bove ◽

Antonio Noro ◽

Angela Iuorio ◽

Mario Santini ◽

...

Keyword(s):

Tracheal Stenosis ◽

Tracheostomy Tube ◽

Percutaneous Tracheostomy

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Is Tracheal Stenosis Caused by Percutaneous Tracheostomy Different From That by Surgical Tracheostomy?

Yearbook of Otolaryngology-Head and Neck Surgery ◽

10.1016/s1041-892x(08)70145-8 ◽

2006 ◽

Vol 2006 ◽

pp. 164-165

Author(s):

M.A. Keefe

Keyword(s):

Tracheal Stenosis ◽

Percutaneous Tracheostomy ◽

Surgical Tracheostomy

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COMPLETE TRACHEAL STENOSIS FOLLOWING PERCUTANEOUS TRACHEOSTOMY

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.2006.04004.x ◽

2007 ◽

Vol 77 (3) ◽

pp. 184-187 ◽

Cited By ~ 5

Author(s):

Hou-Kiat Lim ◽

Michael Tykocinski ◽

Steven Tudge ◽

Peter Thomson

Keyword(s):

Tracheal Stenosis ◽

Percutaneous Tracheostomy

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Tracheal stenosis in prolonged mechanically ventilated patients: prevalence, risk factors, and bronchoscopic management

BMC Pulmonary Medicine ◽

10.1186/s12890-022-01821-6 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Alessandro Ghiani ◽

Konstantinos Tsitouras ◽

Joanna Paderewska ◽

Dieter Munker ◽

Swenja Walcher ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Tracheal Stenosis ◽

Percutaneous Tracheostomy ◽

Binary Logistic Regression Analysis ◽

Interventional Bronchoscopy ◽

Mechanically Ventilated ◽

Ventilated Patients

Abstract Background Various complications may arise from prolonged mechanical ventilation, but the risk of tracheal stenosis occurring late after translaryngeal intubation or tracheostomy is less common. This study aimed to determine the prevalence, type, risk factors, and management of tracheal stenoses in mechanically ventilated tracheotomized patients deemed ready for decannulation following prolonged weaning. Methods A retrospective observational study on 357 prolonged mechanically ventilated, tracheotomized patients admitted to a specialized weaning center over seven years. Flexible bronchoscopy was used to discern the type, level, and severity of tracheal stenosis in each case. We described the management of these stenoses and used a binary logistic regression analysis to determine independent risk factors for stenosis development. Results On admission, 272 patients (76%) had percutaneous tracheostomies, and 114 patients (32%) presented mild to moderate tracheal stenosis following weaning completion, with a median tracheal cross-section reduction of 40% (IQR 25–50). The majority of stenoses (88%) were located in the upper tracheal region, most commonly resulting from localized granulation tissue formation at the site of the internal stoma (96%). The logistic regression analysis determined that obesity (OR 2.16 [95%CI 1.29–3.63], P < 0.01), presence of a percutaneous tracheostomy (2.02 [1.12–3.66], P = 0.020), and cricothyrotomy status (5.35 [1.96–14.6], P < 0.01) were independently related to stenoses. Interventional bronchoscopy with Nd:YAG photocoagulation was a highly effective first-line treatment, with only three patients (2.6%) ultimately referred to tracheal surgery. Conclusions Tracheal stenosis is commonly observed among prolonged ventilated patients with tracheostomies, characterized by localized hypergranulation and mild to moderate airway obstruction, with interventional bronchoscopy providing satisfactory results.

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