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Post-Intubation Tracheal Stenosis: Multicenter Study from 2010 to 2022

DOI : https://doi.org/10.36349/easjacc.2023.v05i04.002
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Objective: To study the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of post-intubation tracheal stenosis occurring in patients admitted to intensive care units. Patients and methods: This is a multicenter, retrospective and descriptive study conducted from November 1, 2010 to June 1, 2022 in 7 intensive care units and 3 ENT departments. From medical records, we collected epidemiological data (frequency, age, sex), medical history, data relating to tracheal intubation (indication, duration, inflation pressure of the intubation tube balloon), data on post-intubation (PI) tracheal stenosis (symptoms and time to onset), paraclinical data, treatment and evolution modalities. The data collected were expressed as averages with their standard deviation. Results: During the study period, 19 patients presented with PI tracheal stenosis. The frequency ranged from 0.03% to 0.1%. The average age of the patients was 25.7 years 11.07 14-38 years. Patients had been intubated in a traumatic context in 47.37% of cases. The average duration of ventilatory support was 10.37 days  03.03 4-15 days No intubation tube cuff pressure monitoring was done for any patient. Dyspnea was the main telltale sign. Its average time to onset was 33.21  days 12.07 1h-3months. Endoscopically, the average degree of tracheal stenosis was 72.63% 50-99% . Therapeutically, in intensive care, 5 patients (26.31%) who presented with acute respiratory failure underwent a life-saving surgical tracheostomy. Curative surgery resulted in a tracheal resection-anastomosis (73.68%) and enlargement tracheoplasty (26.32%). The outcome was favorable for 9 patients (47.37%). The recurrence of the stenosis after curative surgery was observed in 31.58% of cases. Death occured in 3 patients (15.79%). Conclusion: Over-inflation of the intubation tube cuff is the leading cause of PI tracheal stenosis. Prevention is based on the systematic monitoring of its inflation pressure.

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Dr. Afroza Begum

Lecturer, Dept. of Pharmacology and Therapeutics, Shaheed Monsur Ali Medical College & Hospital, Uttara, Dhaka-1230, Bangladesh

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