ABSTRACT
Aims: The objective of our study was to perform the routine analysis of bronchoscopically obtained tracheal samples to determine the appearance and relative distribution of cytokines and antimicrobial proteins in patients with post-intubation tracheal stenosis (PITS). Study Design: Retrospective. Place and Duration of Study: Rīga Stradiņš University, Institute of Anatomy and Anthropology, Pauls Stradiņš Clinical University Hospital, between May 2014 and May 2015. Methodology: Five patients with PITS were involved in this study. Tissue samples were obtained by bronchoscopy from the upper part of trachea, then proceeded for routine histological staining with hematoxylin and eosin. Interleukine-1 (IL-1), interleukine-10 (IL-10) and tumor necrosis factor alpha (TNFα), as well as beta defensin-2 (β def-2) were detected by use of immunohistochemistry (IMH) method. The number of immunoreactive (positive) structures was graded semi-quantitatively. Results: Squamous metaplasia, inflammatory cell infiltration and formation of granulation tissue were observed in all cases. Significant expression of IL-10 and β def-2 was seen as various number of immunoreactive structures in tracheal tissue. Only few scattered IL-1 and TNFα positive macrophages were found in part of cases. Conclusions: The leading role in pathogenesis of post-intubation tracheal stenosis is assumed to be the chronic inflammation, fibrous scarring, as well as the remodeling of tracheal wall due to the ischemia. Compensatory expression of antimicrobial peptide β def-2 and anti-inflammatory cytokine IL-10 indicates the intense local tissue defense reactions. TNFα and IL-1 are not among the most significant factors in pathogenesis of PITS.
ABSTRACT
PURPOSE: Stenting has been developed to deal with airway stenosis and is applicable in patients with post-intubation tracheal stenosis (PITS) in whom surgery would not be indicated. The purpose of this study was to investigate the prognostic factors in inoperable patients in whom a silicone stent was inserted due to PITS. MATERIALS AND METHODS: We retrospectively evaluated 55 PITS patients undergoing silicone stenting between January 2001 and December 2009. RESULTS: Silicone stent was inserted to narrowed trachea after the combination of pre-dilatation including laser cauterization, mechanical bougienation and ballooning. Following airway stabilization, the stent could be removed successfully in 40% (22/55) of the patients after median 12 months of stenting. However, in 60% (33/55) of patients, the stent could not be removed successfully and surgical management was needed after initial stabilization. Multivariate analysis revealed that the stent could be successfully removed more frequently in those who do not have cardiovascular disease [odds ratio (OR)=12.195; p=0.036] and the intervention was performed within 6 months after intubation (OR=13.029; p=0.031). CONCLUSION: Among those patients undergoing silicone stenting due to PITS, the stent could be successfully removed when patients do not have cardiovascular disease and stented within 6 months after intubation.