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Evolution and therapeutical features in post-intubation tracheal stenosis in COPD patients

Emilia Crisan, Alina Croitoru, Ruxandra Ulmeanu, Mihai Alexe, Ion Cordos, Nicolae Galie, Cristian Paleru, Codin Saon, Genoveva Cadar, Iolanda Ion
European Respiratory Journal 2011 38: p614; DOI:
Emilia Crisan
1Bronchology Department, National Institute of Pneumology, Bucharest, Romania
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Alina Croitoru
1Bronchology Department, National Institute of Pneumology, Bucharest, Romania
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Ruxandra Ulmeanu
1Bronchology Department, National Institute of Pneumology, Bucharest, Romania
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Mihai Alexe
1Bronchology Department, National Institute of Pneumology, Bucharest, Romania
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Ion Cordos
2Thoracic Surgery Department, National Institute of Pneumology, Bucharest, Romania
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Nicolae Galie
2Thoracic Surgery Department, National Institute of Pneumology, Bucharest, Romania
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Cristian Paleru
2Thoracic Surgery Department, National Institute of Pneumology, Bucharest, Romania
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Codin Saon
2Thoracic Surgery Department, National Institute of Pneumology, Bucharest, Romania
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Genoveva Cadar
3ICU Department, National Institute of Pneumology, Bucharest, Romania
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Iolanda Ion
3ICU Department, National Institute of Pneumology, Bucharest, Romania
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Abstract

Post-intubation tracheal stenosis represents a severe complication in patients with hypercapnic respiratory failure due to COPD. We present a series of iatrogenic tracheal stenoses in COPD patients addressed to the Bronchology Department during 5 years. There were 13 patients (10 males, 46% over 60 years-old), COPD stage III-IV GOLD, who suffered a severe exacerbation that required oro-tracheal intubation; 8 needed tracheotomy.Tracheal stenoses developed after a mean period of 24 days (7-42) and were clinically significant. Bronchoscopy revealed tracheal stenosis with diameter less than 5 mm. 8 were located in proximal trachea and 5 in medial trachea, with length more than 2 cm in 7 cases and less than 2 cm in other 6. Initially, all were treated with interventional bronchoscopy (dilatation, granuloma resection) but the results were instable in time, requiring other methods: prosthetics (8 cases) or surgery (5 cases). In the patients treated by prosthesis, the stent was removed in 3 cases after 1,5-2 years, the rest remained chronic carriers of prostheses. The patients treated by surgery had significant complications: 1 death by mediastinis, 3 stenosis relapse on the anastomosis line (finally resolved with interventional bronchoscopy). Only one case was successfully solved after surgery. In conclusion, interventional bronchoscopy had a higher success rate (37%) than surgical therapy (20%), also solving the cases complicated post-surgery with reoccurrence of stenosis. While for different etiologies of tracheal stenosis, surgical resection is the first choice of treatment, in patients suffering from COPD, interventional bronchoscopy remains the only way to solve it.

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Evolution and therapeutical features in post-intubation tracheal stenosis in COPD patients
Emilia Crisan, Alina Croitoru, Ruxandra Ulmeanu, Mihai Alexe, Ion Cordos, Nicolae Galie, Cristian Paleru, Codin Saon, Genoveva Cadar, Iolanda Ion
European Respiratory Journal Sep 2011, 38 (Suppl 55) p614;

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Evolution and therapeutical features in post-intubation tracheal stenosis in COPD patients
Emilia Crisan, Alina Croitoru, Ruxandra Ulmeanu, Mihai Alexe, Ion Cordos, Nicolae Galie, Cristian Paleru, Codin Saon, Genoveva Cadar, Iolanda Ion
European Respiratory Journal Sep 2011, 38 (Suppl 55) p614;
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