proposed grading system for post-intubation tracheal stenosis

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

Surgical treatment of post-intubation tracheal stenosis

Incidence of post-intubation tracheal stenoses is relatively high in Iran and the majority of tracheal surgeries are performed to treat these strictures. Therefore, it is important to become familiar with the nature of tracheal stenoses and know their treatment methods. Most surgeons learn different methods of tracheal surgery through operating on cases of post-intubation tracheal stenoses and apply these methods for surgical operation of tracheal tumors. We mainly focused on the technique of tracheal surgery, patient selection, and pre-op and post-op equipments required. Other related fields such as anatomy of the trachea, bronchoscopy, imaging, laser therapy and stenting are mentioned when necessary

Preoperative assessment of mechanical ventilation requirement after surgical treatment of esophageal cancer

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

Evaluation of efficacy, survival rate and complications of peritoneal catheter placement of patients with end-stage renal disease

Peritoneal dialysis [PD] as an equivalent to hemodialysis [HD] is one renal replacement therapy [RRT], which has several advantages compared to hemodialysis. However, most nephrologists are reluctant to apply this method. The purpose of this study is to assess the catheter efficiency, survival rate and complications of PD catheter placement in end-stage renal disease [ESRD] patients. From September 2002 to September 2003, 21 patients were operated by PD catheter placement in Imam Hossein Hospital, Tehran, Iran. The kind of catheter and surgical technique were identical in all patients. After surgery, patients were observed for 6 months. Out of the 21 patients, 13 [61%] were males and 8 [39%] were females. Diabetes and hypertension were the most common cause of nephropathy, mean age was 51.2 years and mean time between operation and from the beginning of PD was 9 days [range 1-14 days]. In 8 [38%] patients, the 2 weeks break-in period was ignored. Complications observed were as follows: peritonitis in 2 [9.5%], leak of dialysate in 2 [9.5%], abdominal wall hernia in 2 [9.5%], catheter malfunction in 2 [9.5%] and abdominal wall hematoma in 2 cases [9.5%]. The catheter lasted 6 months in all cases. However, 12 patients who previously received hemodialysis were more satisfied with PD. From the point of prevalence, our complications were not significantly different from previous studies. The 6-month survival rate and efficiency of catheter was very high. In addition, the rate of satisfaction of patients who received PD was also high. We suggest that more accurate studies on ESRD patients should be carried out to evaluate the use of PD in the primary stage of ESRD instead of HD