Caracterización de estenosis traqueal por intubación prolongada en pacientes adultos / Characterization of tracheal stenosis by prolonged Intubation in adult patients

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

Evaluation of tracheal narrowing post tracheostomy by plain X-ray

The objective of this work is to recognize the incidence and severity of narrowing of the trachea in the head and neck surgical patients who had undergone tracheostomy by doing lateral cervical X-ray. This is a prospective study of 24 adult patients with consecutive tracheostomies conducted in the period from January 2008 to January 2009 in E.N.T Department, Al- Yarmouk Teaching Hospital. Twenty of them [83.3%] had emergency tracheostomy and 4 of them [16.6%] had elective tracheostomy. Analysis was performed with respect to age, sex, time of decannulation, symptoms and the type of operation whether emergency or an elective procedure. The diagnosis of tracheal narrowing after decannulation depends on lateral soft tissue X-ray of the neck. Diameter of the trachea above the stoma [around 2 cm below the cricoid ring that can be clearly seen in lateral X-ray] was taken as control. The study revealed that 83.3% of patients developed narrowing of the trachea post-tracheostomy, however, all the narrowing cases was less than 50%. Very early decannulation of tracheostomy tube showed minimum or no narrowing at all. There is gradual narrowing in patients in whom decannulation were performed after 2 weeks. Male patients had earlier decannulation time compared to female patients. Tracheostomy as live saving procedure results in minimum asymptomatic tracheal stenosis

Incidência e características endoscópicas de lesões das vias aéreas associadas à intubação traqueal em crianças / Incidence and endoscopic characteristics of airway injuries associated with endotracheal intubation in children

OBJETIVO: Descrever a incidência e características endoscópicas de lesões das vias aéreas em crianças submetidas à intubação. MÉTODOS: Durante o período de dois anos (outubro/99 a outubro/01) foi conduzido estudo prospectivo no qual todo paciente intubado, excetuando-se aqueles que evoluíram para óbito e recém-nascidos (RN) com peso inferior a 1.250g, foi submetido à endoscopia respiratória na extubação. Achados endoscópicos foram classificados em leves, moderados ou graves. Descrições foram realizadas por meio de proporções e medianas, comparações feitas por teste qui-quadrado para proporções. RESULTADOS: Foram estudados 61 RN e 154 crianças. Em 89,8 por cento dos pacientes, sendo 55 RN e 138 crianças (p=0,89), foi detectada pelo menos uma lesão somando 507. Pacientes com lesões leves corresponderam a 54,8 por cento (IC95 por cento: 48,1-61,5), aqueles com lesões moderadas foram 24,2 por cento (IC95 por cento: 18,5-30,0) enquanto as graves ocorreram em 10,7 por cento dos pacientes (IC95 por cento: 6,6-14,8). Locais principalmente acometidos foram glote (48,1 por cento das lesões) e subglote (34,9 por cento das lesões). Erosões foram as mais incidentes em ambos os grupos etários (p=0,88). Edema de prega vocal foi a principal lesão moderada em ambos os grupos (p=0,96), seguida por ulcerações (p=0,92). Nódulos fibrosos em pregas vocais e sinéqüias foram as principais lesões graves em ambos os grupos etários (p=0,12). Estenose subglótica foi detectada em 2,8 por cento da população sem diferença entre as faixas etárias (p=0,35). CONCLUSÕES: Verificou-se elevada incidência de lesões em vias aéreas, sem diferença significante entre os grupos etários com relação à incidência e características das lesões. Houve predomínio de lesões leves, lesões na glote e caracterizadas por erosões, edema e ulcerações.

Estenosis laringotraqueal / Laryngotracheal stenosis

The authors reviewed 39 cases of Laryngotracheal stenosis diagnosed in the last 15 years. Etiologic factors, management and resultas were analized. Patients age ranged from 1 month to 63 years old, 16 of them were females and 23 were males. Prolonged endotraqueal intubation was the most common cause, followed by tracheostomy. The subglottic airway was involved in the majority of the patients. Endotracheal intubation was prolonged over 5 days in 63,5% of the cases; 22.7% of the patients develped symptomatic laryngotracheal stenosis around 30 days after extubation. Surgical treatment was performed in 61.5% of the cases; a variety of techniques were used; in this group the decannulation rate was 79%. Expectant observation was the management for 11 patients, withh a decannulation rate of 40%. Endotracheal intubation, tracheostomy and laryngoytracheal stenosis management aspects were analysed