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Airway stenting in the management of iatrogenic tracheal injuries: 10‐Year experience
Author(s) -
TaziMezalek Rachid,
Musani Ali I.,
Laroumagne Sophie,
Astoul Philippe J.,
D'Journo Xavier B.,
Thomas Pascal A.,
Dutau Hervé
Publication year - 2016
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12853
Subject(s) - medicine , tracheotomy , surgery , bronchoscopy , airway , cuff , cannula , stent , tracheoesophageal fistula , tracheal stenosis , mechanical ventilation , tracheomalacia , airway management , fistula , anesthesia
Background and objective Iatrogenic tracheal injury ( ITI ) is a rare yet severe complication of endotracheal tube ( ETT ) placement or tracheostomy. ITI is suspected in patients with clinical and/or radiographic signs or inefficient mechanical ventilation ( MV ) following these procedures. Bronchoscopy is used to establish a definitive diagnosis. Methods We conducted a retrospective, single‐centre chart review of 35 patients between 2004 and 2014. Depending on the nature and location of ITI and need for MV , patients were triaged to surgical repair, endoscopic management with airway stents or conservative treatment consisting of ETT or tracheotomy cannula ( TC ) placement distal to the wound and bronchoscopic surveillance. Results Three of the four patients (11.43%) presenting with tracheoesophageal fistula ( TEF ) underwent surgery. Seven patients (20%) who did not require MV underwent endoscopic surveillance. Of the 24 ventilated patients (68.57%), 7 with ITI in the lower trachea were treated with silicone Y‐stent ( ETT or TC was placed inside the stent) and 17 patients with ITI in the upper trachea were managed by placing ETT or TC cuff distal to the injury. Overall management success, defined as complete healing of the ITI , was seen in 88.57% of patients. Four patients (11.43%) died of non‐ ITI ‐related comorbidities. Conclusion Conservative management should be considered in non‐ventilated patients with ITI and when ITI is located in the upper trachea of ventilated patients where ETT or TC bypasses the injury. Airway stenting should be considered in ventilated patients with ITI located in the lower trachea. Surgery should be reserved for TEF and conservative and endoscopic management failure.