Airway management during unusual tracheal stenosis: A clinical feasibility trial.
COVID‐19 pnemonia
Tritube
flow‐controlled ventilation
tracheal stenosis
Journal
Laryngoscope investigative otolaryngology
ISSN: 2378-8038
Titre abrégé: Laryngoscope Investig Otolaryngol
Pays: United States
ID NLM: 101684963
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
05
06
2023
revised:
12
08
2023
accepted:
18
08
2023
medline:
30
10
2023
pubmed:
30
10
2023
entrez:
30
10
2023
Statut:
epublish
Résumé
Prolonged intubation is a known risk factor of LTS. LTS related to COVID-19 may result in a different phenotype: pronation affects the location of stenosis and COVID-19 pneumonia can decline lung mechanics. Therefore, airway management in these patients may carry unique challenges for both anesthesiologists and surgeons.This prospective observational feasibility trial aims to evaluate the use of a novel thin, cuffed, endotracheal tube (Tritube) in combination with flow-controlled ventilation (FCV) in the management of patients with COVID-19-related LTS undergoing laryngeal surgery. 20 patients suffering from COVID-19-related LTS, as diagnosed by CT, requiring endolaryngeal surgery, with or without CO Median duration of mechanical ventilation during their ICU stay was 17 days, (range, 7-27), and all patients had been pronated. In 18/20 patients, endoscopic diagnosis confirmed the initial CT diagnosis: posterior subglottic stenosis. Surgeons' satisfaction on the view was rated 9 out of 10 (range 7-10), where 0 was the worst view and 10 was the best view. Hemodynamic and respiratory variables were within the normal clinical range during the surgical procedure. One patient that had a SpO2 of 90% before induction of anesthesia, a temporal drop to 89%, caused meeting the predefined requirement of "respiratory complication." This study demonstrates the feasibility of using Tritube with FCV in patients with relatively unusual subglottic posterior location tracheal stenosis, undergoing laryngotracheal surgery. Tritube provides a good surgical field and FCV provides highly adequate ventilation especially in patients with compromised lung mechanics. IV, non-comparitive prospective clinical trial with 20 patients.
Identifiants
pubmed: 37899870
doi: 10.1002/lio2.1151
pii: LIO21151
pmc: PMC10601558
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1169-1177Informations de copyright
© 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Eur J Anaesthesiol. 2019 May;36(5):327-334
pubmed: 30730422
Acta Otorhinolaryngol Ital. 2022 Apr;42(2):189-193
pubmed: 35612512
Auris Nasus Larynx. 2018 Oct;45(5):1047-1052
pubmed: 29373164
JAMA. 2016 Feb 23;315(8):788-800
pubmed: 26903337
J Anesth Analg Crit Care. 2022 Aug 26;2(1):39
pubmed: 37386531
Acta Anaesthesiol Scand. 2020 Apr;64(4):481-488
pubmed: 31828755
Anaesth Rep. 2021 May 07;9(1):86-89
pubmed: 33982000
Eur J Anaesthesiol. 2018 Oct;35(10):736-744
pubmed: 29734208
Front Surg. 2020 Feb 28;7:6
pubmed: 32185179
Masui. 2004 Jun;53(6):682-6
pubmed: 15242045
J Laryngol Otol. 2017 Mar;131(3):264-267
pubmed: 28007041
J Thorac Dis. 2016 Mar;8(Suppl 2):S140-7
pubmed: 26981264
J Laryngol Otol. 2016 May;130(S2):S23-S27
pubmed: 27841108
OTO Open. 2021 Aug 24;5(3):2473974X211041040
pubmed: 34458661
BMC Anesthesiol. 2021 May 12;21(1):145
pubmed: 33980178
Eur Arch Otorhinolaryngol. 2021 Jan;278(1):1-7
pubmed: 32506145
Laryngoscope. 1977 Mar;87(3):339-46
pubmed: 839929
Ann Otol Rhinol Laryngol. 1994 Apr;103(4 Pt 1):319-23
pubmed: 8154776
Laryngoscope Investig Otolaryngol. 2020 Oct 30;5(6):1117-1124
pubmed: 33364402
Eur J Anaesthesiol. 2022 Nov 1;39(11):885-894
pubmed: 36125005
Ear Nose Throat J. 2007 Nov;86(11):687-90
pubmed: 18225632
Otolaryngol Head Neck Surg (1979). 1980 Nov-Dec;88(6):765-72
pubmed: 7208045
Eur Arch Otorhinolaryngol. 2016 Feb;273(2):419-24
pubmed: 26335288
J Clin Anesth. 1995 Feb;7(1):89-91
pubmed: 7772368
Eur J Anaesthesiol. 2022 Oct 1;39(10):835-837
pubmed: 35875915
BMC Anesthesiol. 2020 Jan 28;20(1):24
pubmed: 31992213
Surg Clin North Am. 1991 Dec;71(6):1211-30
pubmed: 1948570
J Laryngol Otol. 2021 Jul;135(7):656-658
pubmed: 33973511
PLoS One. 2021 Jun 4;16(6):e0252347
pubmed: 34086717
Ann Surg. 1969 Mar;169(3):334-48
pubmed: 5266019
Eur Arch Otorhinolaryngol. 2015 Oct;272(10):2885-96
pubmed: 25951790
Lancet. 2020 Jun 6;395(10239):1763-1770
pubmed: 32442528
Eur Arch Otorhinolaryngol. 2005 Aug;262(8):609-15
pubmed: 15668812
Anaesthesiol Intensive Ther. 2022;54(1):62-70
pubmed: 35142160
Br J Anaesth. 1998 Dec;81(6):979-81
pubmed: 10211034
Eur J Anaesthesiol. 2019 Dec;36(12):963-971
pubmed: 31644514
Acta Anaesthesiol Scand. 2017 Jul;61(6):580-589
pubmed: 28436022
Lancet Respir Med. 2020 May;8(5):475-481
pubmed: 32105632
Can J Anaesth. 1993 Sep;40(9):875-8
pubmed: 8403183
Laryngoscope. 2022 May;132(5):1075-1081
pubmed: 34516003