ABSTRACT
Tracheal stenosis is still a serious consequence of endotracheal intubation. Previous classification systems are commonly descriptive and are not intended to deal with management approach. The aim of this study was to present a classification system for post intubation tracheal stenosis and evaluate its efficacy in distinguishing critically ill patients who need surgical intervention. This classification system was developed based on size and type of stenosis and associated clinical signs and symptoms. Stenosis was graded based on the results of clinical examination and rigid bronchoscopy. All patients received surgical or conservative treatment based on the judgment of a surgeon experienced in management of post-intubation tracheal stenosis without considering their score. ROC curve analysis was done and cut-off point was established based on the greatest Youden index. Sixty patients were studied. Resection and anastomosis were done for 49 patients. The mean score for all samples was 9.18 [range 8.77-9.45]. Chosen cutoff point was 8.5 and calculated sensitivity and specificity were 89% and 42%, respectively. Positive and negative predictive values were 83.7% and 54.5%, respectively. A reasonable agreement between the estimated score and surgeon's clinical judgment [kappa=0.78] was observed. A statistically significant relationship was observed between scores greater than 8.5 and need for surgical intervention [P= 0.007]. We presented a scoring system for post-intubation and tracheostomy tracheal stenosis using main factors influencing diagnosis and treatment and its efficacy was evaluated prospectively. It seems that this system would be capable of assimilating the treatment interventions and comparing them
ABSTRACT
Although resection and anastomosis [RA] is known as most efficient method for treatment of post-intubation airway stenoses, non-resectional methods are being developed and suggested as substitutes for RA. Presenting our experience with sufficient number of patients who underwent resection might be helpful in comparison and selection of various treatment methods. All patients who had been referred to us [Feb 1994 to Jan 2007] underwent bronchoscopy and evaluation of the stricture and function of the larynx. Patients in good general condition whose strictures were operable by RA underwent this operation. Other patients underwent non-resectional treatments. Three types of operations were performed 1] tracheal resection 2] resection of trachea and anterior arch of cricoid 3] resection of trachea and anterior arch of cricoid associated with posterior cricoidotomy and autologous cartilage grafting at the site of cricoidotomy. Surgical results were categorized into good, acceptable and failure. Results were analyzed using SPSS software with Chi-square and Fisher's exact tests. Nine hundred one patients underwent treatment during 13 years out of which, 571 underwent RA [420 men, 151 women, mean age 25.6 yrs]. Types 1, 2 and 3 operations were performed on 451, 88 and 32 patients, respectively. Results were good in 434 [76.10%], acceptable in 79 [13.84%] and failure in 53 [9.29%] patients. Thirteen deaths occurred after resectional treatment and 25 deaths after non-resectional treatments. Single-stage resection and anastomosis is an appropriate treatment for most cases of post-intubation tracheal and laryngotracheal stenoses