ABSTRACT
La estenosis traqueal es la disminución del calibre de la luz laríngea y traqueal como resultado de la maduración de tejido cicatrizal por lesión isquémica que el balón del tubo endotraqueal produce sobre las mucosas de la pared laringo traqueal cuando es insuflada por encima de la presión capilar (20-30 mm Hg) por un periodo incluso corto. La Asociación Americana de Cuidados Respiratorios recomienda que se utilice intubación para aquellos pacientes que ameriten ventilación mecánica por 7-10 días o menos y traqueostomía para aquellos pacientes que necesitan ventilación por más tiempo. Objetivo: Caracterizar la estenosis traqueal por intubación prolongada. Metodología: Se realizó un estudio descriptivo, retrospectivo que incluyó pacientes adultos con diagnóstico de estenosis traqueal por intubación mayor de 7 días en el Hospital General San Juan de Dios durante enero 2016 a diciembre 2019. Se evaluaron los datos epidemiológicos, clínicos, diagnóstico y terapéuticos en los registros clínicos de los servicios de cirugía torácica, otorrinolaringología y neumología. Resultados: Se evaluaron 52 pacientes adultos con intubación traqueal prolongada que desarrollaron estenosis traqueal. La mayoría son hombres jóvenes con mediana de intubación de dos semanas, la indicación de intubación más frecuente fue por trauma craneoencefálico severo. La forma de diagnóstico más frecuente fue clínico seguido por radiografía y tomografía teniendo en su mayoría estenosis tipo I y II. La mayoría de los pacientes con estenosis traqueal son tratados de manera quirúrgica, comúnmente con traqueostomía, dos semanas después del primer día de intubación. La única variable asociada al tipo de tratamiento fue que se le realizara al paciente una traqueotomía, la cual fue la forma de tratamiento quirúrgico de la mayoría de los pacientes para la corrección de la estrechez traqueal (p=0.01). Conclusiones: el tiempo de intubación endotraqueal es determinante para el desarrollo de la estenosis traqueal. En este estudio se documentaron 52 pacientes que recibieron intubación traqueal prolongada y desarrollaron estenosis traqueal tras una mediana de intubación de dos semanas, lo cual deberá hacernos reflexionar sobre las prácticas y guías para implementar la realización de traqueostomías tempranas en pacientes ventilados después de 7 días (AU)
Tracheal stenosis is the decrease in the caliber of the laryngeal and tracheal lumen as a result of the maturation of scar tissue due to ischemic injury that the balloon of the endotracheal tube produces on the mucosa of the laryngo-tracheal wall when it is insufflated above capillary pressure (20-30 mm Hg) for an even short period. The American Association for Respiratory Care recommends that intubation be used for those patients who require mechanical ventilation for 7-10 days or less and tracheostomy for those patients who require ventilation for longer. Objective: To characterize tracheal stenosis due to prolonged intubation. Methodology: A descriptive, retrospective study was carried out that included adult patients with a diagnosis of tracheal stenosis due to intubation greater than 7 days at the San Juan de Dios General Hospital from january 2016 to december 2019. Epidemiological, clinical, diagnostic and therapeutic data were evaluated in the clinical records of the thoracic surgery, otorhinolaryngology and pulmonology services. Results: 52 adult patients with prolonged tracheal intubation who developed tracheal stenosis were evaluated. Most are young men with a median intubation of two weeks, the most frequent indication for intubation was for severe head trauma. The most frequent form of diagnosis was clinical followed by radiography and tomography, mostly type I and II stenosis. Most patients with tracheal stenosis are treated surgically, commonly with a tracheostomy, two weeks after the first day of intubation. The only variable associated with the type of treatment was that the patient underwent a tracheostomy, which was the form of surgical treatment for most patients to correct the tracheal narrowing (p = 0.01). Conclusions: endotracheal intubation time is decisive for the development of tracheal stenosis. In this study, 52 patients who received prolonged tracheal intubation and developed tracheal stenosis after a median intubation of two weeks were documented, which should make us reflect on the practices and guidelines for implementing early tracheostomies in patients ventilated after 7 days
Subject(s)
Humans , Male , Middle Aged , Tracheal Stenosis/classification , Tracheal Stenosis/epidemiology , Intubation, Intratracheal/methods , Tracheostomy/methods , Cyanosis/etiology , Craniocerebral Trauma/complicationsABSTRACT
This is a retrospective study examining the outcome of paediatric patients with subglottic stenosis who underwent partial cricotracheal resection (PCTR) as a primary open procedure from 2004 to 2012. There were 5 patients identified aged from 3 to 18 years old. All the subglottic stenosis were acquired type. All of them were secondary to prolonged intubation. Three patients were classified as Myer-Cotton grade III and the other two were Myer-Cotton grade IV. Two of the patients had concomitant bilateral vocal cord immobility. All patients underwent two staged PCTR . All patients underwent two staged PCTR, and one patient underwent posterior cordectomy apart from partial CTR at different setting. All patients were successfully decannulated at various durations postoperatively. Although this is an early experience in our institution, PCTR has shown to be effective and safe procedure in patients with subglottic stenosis especially those with Myer-Cotton grade III and IV.
ABSTRACT
Objetivo: Determinar a faixa etária, indicações e complicações de traqueostomia realizada em crianças até 12 anos de idade. Métodos: Revisão retrospectiva de 26 crianças submetidas à traqueostomia no período de novembro de 1999 a julho de 2003, em hospital geral terciário. Resultados: Aidade média das crianças foi de 32 meses; 17 (65,4%) eram menores de 1 ano. O procedimento foi eletivo em 20 (76,9%) e de emergência 6 (22,1%). As principais indicações foram ventilação mecânica prolongada em 13 (50%), estenose subglótica em 5 (19,3%) e malformações congênitas em 4 (15,4%). As complicações foram tecido de granulação no traqueostoma em 7 (26,9%), hemorragia em 3 (11,5%), obstrução da cânula em 3 (11,5%), enfisema subcutâneo em 2 (7,7%), pneumotórax em 2 (7,7%), decanulaçao acidental em 2 (7,7%), estenose laríngea em 1 (3,8%) e infecção da ferida operatória em 1 (3,8%). Não foram observadas diferenças significativas entre as complicações observadas nos procedimentos eletivos e de urgência. Treze pacientes morreram por complicações não relacionadas à traqueostomia; onze (42,2%) permaneceram com traqueostomia, e 2 (7,7%) foram decanulados. Conclusões: Nos últimos anos ocorreram mudanças nas indicações e faixa etária das crianças submetidas à traqueostomia: ela é mais comumente realizada em crianças menores de um ano, e mais freqüentemente devido à intubação prolongada. A traqueostomia é um procedimento seguro quando é realizada por cirurgião treinado com a técnica cirúrgica e com cuidados pós-operatórios de hospital terciário de referência (AU)
Objective: To determine age of surgery, indications and complications of tracheostomy in children until 12 years old. Method: Retrospective review of 26 children submitted to tracheostomy from November 1999 to July 2003 at a tertiary general hospital. Results: The mean age was 32 months; 17 (65.4%) were under 1 year old. In 20 (76.9%) the procedure was elective, whereas in 6 (22.1%) it was performed as emergency. The main indications of tracheostomy were prolonged mechanical ventilation in 13 patients (50%), subglottic stenosis in 5 (19.3%) and congenital malformations in 4 (15.4%). The most common complications were granulation at the site of the stoma in 7 (26.9%), bleeding in 3 (11.5%) , blockage of the cannula in 3 (11.5%), subcutaneous emphysema in 2 (7.7%) , pneumothorax in 2 (7.7%), accidental decannulation in 2 (7.7%), larynx stenosis in 1 (3.8%), surgical wound infection in 1 (3.8%). Regarding complications , it was not observed any significant difference between elective and emergency procedures. Thirteen patients (50%) died due to complications not related to the tracheostomy; eleven (42.2%) kept the tracheostomy, and 2 (7.7%) were decannulated. Conclusions: In the last few years there were changes in pediatric tracheostomy. It is being indicated more often in children under one year old, and more recently due to prolonged intubation. Tracheostomy is a safe procedure when performed by trained surgeon with appropriate technique and postoperative care at tertiary hospital (AU)
Subject(s)
Humans , Child , Tracheostomy/trends , Airway Obstruction/surgery , Postoperative Complications , Tracheostomy/adverse effects , Treatment Outcome , Airway Obstruction/etiologyABSTRACT
Nosocomial pneumonia, which can develop in patients with prolonged intubation, may have in fatal consequences. The histamine type 2 blockers used for prevention of stress ulcers, increases gastric pH, and may increase the incidence of nosocomial pneumonia in patients with prolonged intubation by promoting bacterial overgrowth in the stomach and retrograde colonization in the trachea. We assessed the effect of histamine type 2 blockers on the incidence of nosocomial pneumonia in patients with prolonged intubation, who were admitted to the Intensive Care Unit, Young Dong Severance Hospital, Yonsei University College of Medicine from September 1992 to February 1993. The patients were divided into two groups Group 1 was the patients given histamine type 2 blockers and total parenteral nutrition, and Group 2 was the patients not given histamine type 2 blockers and with enteral feeding through the gastric tube. Gastric juice was aspirated for measurement of gastric pH. A culture of isolates was grown from endotracheal secretion and pharyngeal swab for identification of isolate cultured. Chest X-rays were taken for assess of pneumonic infiltrate, The results were as follows ;. 1. There were no difference of age, APACHE II scores at admission to ICU, duration of ICU stay and mortality between the two groups. 2. Gastric pH differed significantly between the two groups. In group 2, there was a significant difference between gastric pH before and after feeding. 3. The incidence of upper gastrointestinal bleeding did not differ between the two groups. 4. Colonization developed more frequently in the patients with enteral feeding. 5. The incidence of retrograde colonization was higher in patients with enteral feeding. 6. The incidence of nosocomial pneumonia were 30 and 40 percent, and there was no significant difference between the two groups. From our study, the incidence of nosocomial pneumonia was not different significantly between the two groups although gastric pH differed significantly.