ABSTRACT
AIM: The SARS-CoV-2 pandemic may increase the incidence of iatrogenic laryngotracheal stenosis (LTS), whereas management is not well defined. The aim of this study was to survey a panel of French otorhinolaryngologists about their practices and to evaluate their needs. METHOD: A national-level survey of the management of iatrogenic LTS was conducted using a 41-item questionnaire, in 4 sections, sent to a panel of French otorhinolaryngologists between July and December 2022. The main endpoint was heterogeneity in responses between 55 proposals on LTS management. RESULTS: The response rate was 20% (52/263). The response heterogeneity rate was 69% (38/55). Heterogeneity concerned general questions on diagnosis (7/12, 58%) and management (7/10, 70%), LTS case management (22/27, 81%), and otorhinolaryngologists' expectations (33%, 2/6). Quality of training was considered good or excellent by only 21% of respondents. More than 80% were strongly in favor of creating national guidelines, expert centers and a national database. DISCUSSION: This study demonstrated the heterogeneity of adult post-intubation LTS management between otorhinolaryngologists in France. Training quality was deemed poor or mediocre by a majority of respondents. They were in favor of creating national guidelines and expert centers in LTS.
Subject(s)
COVID-19 , Intubation, Intratracheal , Laryngostenosis , Tracheal Stenosis , Humans , COVID-19/epidemiology , France/epidemiology , Tracheal Stenosis/etiology , Tracheal Stenosis/epidemiology , Laryngostenosis/etiology , Laryngostenosis/epidemiology , Intubation, Intratracheal/statistics & numerical data , Intubation, Intratracheal/adverse effects , Adult , Surveys and Questionnaires , Practice Patterns, Physicians'/statistics & numerical data , Iatrogenic Disease/epidemiology , OtolaryngologyABSTRACT
We previously developed a model of acute cyclosporine A (CsA)-induced vasomotor nephrotoxicity in rabbits. In the present study, we evaluated the role of endothelin (ET), angiotensin II (AII) and adenosine in this experimental model. All animals received CsA (25 mg/kg/day) for 5 days. Renal function parameters were first measured in a 30-min period, showing renal insufficiency in all animals. Then, rabbits were administered bosentan (10 mg/kg; antagonist of ET(AB) receptors), perindopril (20 microg/kg; angiotensin-converting enzyme inhibitor), or theophylline (1 mg/kg; adenosine receptor blocker at micromolar concentrations). After a 40-min equilibration period, renal function was assessed again for 30 min. Bosentan, perindopril and theophylline significantly reduced renal vascular resistance (-28+/-5%, -39+/-7% and -8+/-3%, respectively), and improved renal blood flow (+38+/-15%, +66+/-16% and +20+/-5%), glomerular filtration rate (+33+/-9%, +52+/-13% and +50+/-8%) and diuresis (+48+/-9%, +76+/-19% and +73+/-14%). Filtration fraction was unchanged with bosentan, decreased with perindopril (-10+/-9%) and increased with theophylline (+24+/-5%). The overall results suggest that ET, AII and adenosine are involved in the acute renal failure induced by CsA. We conclude that CsA administration for 5 days induced a vasomotor nephropathy with ET- and adenosine-mediated afferent arteriolar constriction as well as ET- and AII-mediated efferent arteriolar constriction.
