RT Journal Article
SR Electronic
T1 Evolution and therapeutical features in post-intubation tracheal stenosis in COPD patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP p614
VO 38
IS Suppl 55
A1 Emilia Crisan
A1 Alina Croitoru
A1 Ruxandra Ulmeanu
A1 Mihai Alexe
A1 Ion Cordos
A1 Nicolae Galie
A1 Cristian Paleru
A1 Codin Saon
A1 Genoveva Cadar
A1 Iolanda Ion
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/p614.abstract
AB 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.