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Objective To evaluate the safety and effectiveness of excessive dynamic airway collapse(EDAC)treated by laser.Methods 13 patients with EDAC confirmed by bronchoscopy from January 2018 to August 2022 were selected and divided into a simple EDAC group(6 cases)and an EDAC combined with tracheobronchomalacia(TBM)group(7 cases)based on whether they were combined with TBM.All patients underwent laser tracheobronchoplasty under bronchoscope.Symptoms,airway collapse,oxygenation index,modified version of British Medical Research Council dyspnoea scale(mMRC)and 6 min walking test before and after treatment were compared to evaluate the therapeutic effect.Results 13 patients underwent 17 times of laser tracheobronchoplasty with laser power of 8～15 W,and 4 patients underwent 2 times of laser tracheobronchoplasty.After treatment,the clinical symptoms of cough,sputum,shortness of breath and dyspnea were improved in all patients.1 week post-treatment,the EDAC group showed a significant improvement in airway lumen stenosis,with a significant statistical difference(P<0.05),1 month post-treatment,enhancements were observed in airway stenosis,oxygenation index,FEV1%,6-minute walk test,and mMRC,which remained stable over a 6 month follow-up.In the EDAC + TBM group,significant enhancements in airway stenosis,oxygenation index,and mMRC were noted 1 week post-treatment,with statistical significance(P<0.05).Between 8 d～6 months post-treatment,some patients exhibited a recurrence of airway stenosis,necessitating comprehensive interventions like balloon dilation,cryotherapy,and stent insertion.Local necrosis and granuloma occurred in some patients after laser therapy,and no serious complications associated with laser intervention were found in all patients.Conclusion Laser tracheobronchoplasty is a safe and effective technique for the treatment of EDAC.For patients with EDAC alone,the therapeutic effect is good,but for patients with EDAC combined with TBM,the long-term effect is not good.
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RESUMEN Introducción: El objetivo del presente trabajo es describir la evolución clínica de dos pacientes adultos internados en un hospital de la Ciudad Autónoma de Buenos Aires que requirieron ventilación mecánica invasiva (VMI) y desarrollaron lesión traqueal detectada mediante fibrobroncoscopia. Presentación de casos: El primer paciente, 34 años, ingresó a la unidad de terapia intensiva (UTI) por neumonía grave secundaria a enfermedad por coronavirus 2019 (COVID-19). Requirió VMI, fue traqueostomizado y diagnosticado posteriormente con una fístula traqueoesofágica. Luego de la desvinculación, se le colocó una prótesis Montgomery y egresó voluntariamente del hospital. El segundo paciente, 55 años, ingresó a la UTI por neumonía grave secundaria a COVID-19. Requirió VMI y fue traqueostomizado. Por medio de una fibrobroncoscopia, se observó necrosis del primer y segundo anillo traqueal, que generó estenosis traqueal y colapso dinámico excesivo de la vía aérea. Una vez desvinculado, se le colocó una prótesis Montgomery y fue finalmente derivado a una clínica de rehabilitación. Conclusión: Se describió la evolución clínica de dos pacientes con neumonía grave por COVID-19 que presentaron lesiones traqueales.
ABSTRACT Introduction: The objective of this study is to describe the clinical course of two adult patients admitted to a hospital of the Autonomous City of Buenos Aires who required invasive mechanical ventilation (IMV) and developed tracheal lesions found by fiberoptic bronchoscopy. Case presentation: The first patient, aged 34, was admitted to the intensive care unit (ICU) with severe pneumonia secondary to COVID-19. The patient required IMV and a tracheostomy. He was subsequently diagnosed with a tracheoesophageal fistula. After weaning, he was fitted with a Montgomery prosthesis and voluntarily discharged. The second patient, aged 55, was admitted to the ICU with severe pneumonia secondary to COVID-19. The patient required IMV and a tracheostomy. Fiberoptic bronchoscopy showed necrosis of the first and second tracheal ring, generating subglottic stenosis and excessive dynamic airway collapse. After weaning, he was fitted with a Montgomery prosthesis and finally transferred to a rehabilitation clinic. Conclusion: We described the clinical course of two patients with severe pneumonia due to COVID-19 who developed tracheal lesions.