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
The risk of pulmonary complications after esophagectomy is higher than after any other common operation, including major lung resection. In this study, we sought to identify risk factors associated with the development of pulmonary insufficiency requiring mechanical ventilation to identify preoperative parameters involved in the estimation of the risk of pulmonary insufficiency. We performed a retrospective cohort study on consecutive patients undergoing esophagectomy for malignancy in the Thoracic Surgery Department of Modarres Hospital in Tehran from March 2002 to February 2006. Patients were assigned into two groups based on whether they required mechanical ventilation or not. Preoperative, operative, and postoperative data were compared among the two groups. To find predictive variables for requiring mechanical ventilation, backward stepwise regression analysis was carried out with risk factors as independent variables and the need for ventilatory support as the dependent variable. The study population included 77 males and 43 females with a mean age of 60.16 +/- 12.04 years [range 29-79 years]. Twenty-seven patients [27.7%] required mechanical ventilatory support. Multivariate analysis revealed sex [Odds ratio: 4.590, Cl 95%: 1.246-16.411] as a confounder and duration of operation [Odds Ratio: 1.677, Cl95%: 1.102-2.533] as a risk factor for requiring mechanical ventilation. Proper patient selection for esophagectomy is important for reducing the postoperative mortality and morbidity and benefiting from a radical resection