Association between surgical tracheostomy and chronic tracheal stenosis: A retrospective, single-center study.
computed tomography
intubation
surgical tracheostomy
tracheal stenosis
triangulation
Journal
Frontiers in medicine
ISSN: 2296-858X
Titre abrégé: Front Med (Lausanne)
Pays: Switzerland
ID NLM: 101648047
Informations de publication
Date de publication:
2022
2022
Historique:
received:
22
09
2022
accepted:
17
11
2022
entrez:
22
12
2022
pubmed:
23
12
2022
medline:
23
12
2022
Statut:
epublish
Résumé
Tracheal stenosis is a major complication of tracheostomy. Accordingly, anesthesiologists tend to select a smaller endotracheal tube (ETT) than usual for patients with a prior tracheostomy history, regardless of the presence or absence of respiratory symptoms. However, it likely comes from our trial and error, not scientific evidence. Therefore, in this study, we retrospectively examined the association between traditional surgical tracheostomy and tracheal stenosis as assessed by transverse computed tomography (CT). Patients who underwent surgery for head and neck cancer from January 2010 to December 2013, with a temporary tracheostomy closed within a couple of months, were included. Exclusion criteria were tracheostoma before surgery, permanent tracheostomy, or insufficient CT follow-up. Transverse CT slices were measured 2 cm above and below the tracheostomy site (0.5 cm/slice for a total of 9 slices). The minimum cross-sectional tracheal area and horizontal and vertical diameters in transverse CT slices were compared before (baseline: BL), 6 months (6M) and 12 months (12M) after tracheostomy. Tracheal stenosis was defined as a decrease in the minimum cross-sectional tracheal area compared to BL. Of 112 patients, 77 were included. The minimum tracheal area was significantly decreased at 6M and 12M compared to BL (BL: mean 285 [SD 68] mm Conventional surgical tracheostomy was associated with a decreased horizontal diameter of the trachea. It resulted in a decreased cross-sectional tracheal area in more than one-half of the patients; however, no patient complained of any respiratory symptoms. Therefore, even without respiratory symptoms, prior tracheostomy causes an increased risk of tracheal stenosis, and using a smaller ETT than usual could be reasonable.
Sections du résumé
Background
UNASSIGNED
Tracheal stenosis is a major complication of tracheostomy. Accordingly, anesthesiologists tend to select a smaller endotracheal tube (ETT) than usual for patients with a prior tracheostomy history, regardless of the presence or absence of respiratory symptoms. However, it likely comes from our trial and error, not scientific evidence. Therefore, in this study, we retrospectively examined the association between traditional surgical tracheostomy and tracheal stenosis as assessed by transverse computed tomography (CT).
Methods
UNASSIGNED
Patients who underwent surgery for head and neck cancer from January 2010 to December 2013, with a temporary tracheostomy closed within a couple of months, were included. Exclusion criteria were tracheostoma before surgery, permanent tracheostomy, or insufficient CT follow-up. Transverse CT slices were measured 2 cm above and below the tracheostomy site (0.5 cm/slice for a total of 9 slices). The minimum cross-sectional tracheal area and horizontal and vertical diameters in transverse CT slices were compared before (baseline: BL), 6 months (6M) and 12 months (12M) after tracheostomy. Tracheal stenosis was defined as a decrease in the minimum cross-sectional tracheal area compared to BL.
Results
UNASSIGNED
Of 112 patients, 77 were included. The minimum tracheal area was significantly decreased at 6M and 12M compared to BL (BL: mean 285 [SD 68] mm
Conclusion
UNASSIGNED
Conventional surgical tracheostomy was associated with a decreased horizontal diameter of the trachea. It resulted in a decreased cross-sectional tracheal area in more than one-half of the patients; however, no patient complained of any respiratory symptoms. Therefore, even without respiratory symptoms, prior tracheostomy causes an increased risk of tracheal stenosis, and using a smaller ETT than usual could be reasonable.
Identifiants
pubmed: 36544500
doi: 10.3389/fmed.2022.1050784
pmc: PMC9760679
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1050784Informations de copyright
Copyright © 2022 Kuwabara, Yamakawa, Okui, Miyazaki and Uezono.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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