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Ahmadian D, Wehbi N, Tseng P, Bixby B, Yip HT. Assessing the interrater and intrarater reliability of subglottic stenosis grading systems. Am J Otolaryngol 2024; 45:104323. [PMID: 38677144 DOI: 10.1016/j.amjoto.2024.104323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Subglottic stenosis (SGS) is a condition leading to narrowing of the upper airway which can lead to dyspnea and life-threatening airway obstruction. Although other proposed grading systems exist, the Cotton Myer (CM) and percent stenosis systems are the most widespread in clinical practice. Despite this, the CM system has not yet been validated for visual assessment of SGS. OBJECTIVE To determine the interrater and intrarater reliability of the CM grading system among a cohort of physicians who manage patients with SGS. METHODS An online survey created with videos of tracheoscopies from 20 adult patients with subglotticstenosis (SGS) was sent individually to 9 expert physicians from various medical specialties, all of whom managed patients with SGS. Physicians were asked to view the 20 tracheoscopy videos and assess both the percent stenosis and Cotton Myer (CM) grade of each patient. After a period of 4 weeks, the physicians were sent the same survey of the 20 tracheoscopy videos. The interrater and intrarater reliability was calculated using the intraclass correlation coefficient (ICC), a measurement used to evaluate the reliability (the extent to which a measurement can be replicated) of two or more raters measuring the same subject. RESULTS Overall, CM and percent stenosis systems were found to have an ICC of 0.94 and 0.90 within the domain of interrater reliability, respectively, and ICC of 0.71 and 0.81 within the domain of intrarater reliability, respectively. CONCLUSION Our findings suggest that the CM and percent stenosis grading systems remain a valid clinical tool to measure and communicate the severity of airway obstruction in SGS.
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Affiliation(s)
- David Ahmadian
- University of Arizona, College of Medicine - Tucson, 1501 N Campbell Ave, Tucson, AZ 85724, United States of America.
| | - Nader Wehbi
- University of Arizona, College of Medicine - Phoenix, 475 N 5th St, Phoenix, AZ 85004, United States of America
| | - Phil Tseng
- University of Arizona, College of Medicine - Tucson, 1501 N Campbell Ave, Tucson, AZ 85724, United States of America
| | - Billie Bixby
- University of Arizona, College of Medicine - Tucson, Department of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724, United States of America
| | - Helena T Yip
- University of Arizona, College of Medicine - Tucson, Department of Otolaryngology, 1501 N Campbell Ave, Tucson, AZ 85724, United States of America
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Bae SY, Lee JH, Kwon HW, Cho S, Kwon C, Kim WH, Kwak JG. Outcomes of not using tracheoplasty in asymptomatic tracheal stenosis found during open-heart surgery. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae030. [PMID: 38441273 PMCID: PMC10948281 DOI: 10.1093/icvts/ivae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/02/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVES We aimed to review the outcomes of treating incidentally encountered asymptomatic airway stenosis during open-heart surgery conservatively without the use of tracheoplasty. METHODS Between January 2002 and October 2022, 25 patients were incidentally diagnosed with tracheal stenosis during open-heart surgery. Intraoperative bronchoscopy and/or laryngoscopy revealed tracheal stenosis; however, this was not consistent with the findings of the preoperative computed tomography. Patients who were diagnosed with a pulmonary artery or vascular sling or had moderate-to-severe respiratory symptoms before open-heart surgery were excluded. RESULTS The median age and weight of the patients at operation were 3.0 months and 5.1 kg, respectively. They were categorized as those having tracheal stenosis on preoperative computed tomography (n = 12) or not having tracheal stenosis (n = 13). The narrowest diameter was significantly smaller in the former group (3.0 vs 5.8 mm, P < 0.05). The rates of reintubation and the tracheostomy, and intubation days tended to be higher in former group without statistical significance. Stenotic degree improved 2 months and 1 year or more after the operation (39.3% at operation, 28.4% at 2 months, 12.5% after 1 year). All patients were Ross class 1 or 2 at follow-up (mean, 7.1 years). CONCLUSIONS Patients with tracheal stenosis showed tolerable long-term outcomes without using tracheoplasty. Accordingly, if tracheal stenosis, that would cause intubation difficulty, was incidentally revealed, concomitant tracheoplasty may not be required during open-heart surgery if the stenosis did not cause considerable symptoms or signs preoperatively.
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Affiliation(s)
- Seon Yong Bae
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Chiheon Kwon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Mangiameli G, Perroni G, Costantino A, De Virgilio A, Malvezzi L, Mercante G, Giudici VM, Ferraroli GM, Voulaz E, Giannitto C, Acocella F, Onorati I, Martinod E, Cariboni U. Analysis of Risk Factors for Tracheal Stenosis Managed during COVID-19 Pandemic: A Retrospective, Case-Control Study from Two European Referral Centre. J Pers Med 2023; 13:jpm13050729. [PMID: 37240899 DOI: 10.3390/jpm13050729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/08/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Benign subglottic/tracheal stenosis (SG/TS) is a life-threatening condition commonly caused by prolonged endotracheal intubation or tracheostomy. Invasive mechanical ventilation was frequently used to manage severe COVID-19, resulting in an increased number of patients with various degrees of residual stenosis following respiratory weaning. The aim of this study was to compare demographics, radiological characteristics, and surgical outcomes between COVID-19 and non-COVID patients treated for tracheal stenosis and investigate the potential differences between the groups. MATERIALS AND METHODS We retrospectively retrieved electronical medical records of patients managed at two referral centers for airways diseases (IRCCS Humanitas Research Hospital and Avicenne Hospital) with tracheal stenosis between March 2020 and May 2022 and grouped according to SAR-CoV-2 infection status. All patients underwent a radiological and endoscopic evaluation followed by multidisciplinary team consultation. Follow-up was performed through quarterly outpatient consultation. Clinical findings and outcomes were analyzed by using SPPS software. A significance level of 5% (p < 0.05) was adopted for comparisons. RESULTS A total of 59 patients with a mean age of 56.4 (±13.4) years were surgically managed. Tracheal stenosis was COVID related in 36 (61%) patients. Obesity was frequent in the COVID-19 group (29.7 ± 5.4 vs. 26.9 ± 3, p = 0.043) while no difference was found regarding age, sex, number, and types of comorbidities between the two groups. In the COVID-19 group, orotracheal intubation lasted longer (17.7 ± 14.5 vs. 9.7 ± 5.8 days, p = 0.001), tracheotomy (80%, p = 0.003) as well as re-tracheotomy (6% of cases, p = 0.025) were more frequent and tracheotomy maintenance was longer (21.5 ± 11.9 days, p = 0.006) when compared to the non-COVID group. COVID-19 stenosis was located more distal from vocal folds (3.0 ± 1.86 vs. 1.8 ± 2.03 cm) yet without evidence of a difference (p = 0.07). The number of tracheal rings involved was lower in the non-COVID group (1.7 ± 1 vs. 2.6 ± 0.8 p = 0.001) and stenosis were more frequently managed by rigid bronchoscopy (74% vs. 47%, p = 0.04) when compared to the COVID-19 group. Finally, no difference in recurrence rate was detected between the groups (35% vs. 15%, p = 0.18). CONCLUSIONS Obesity, a longer time of intubation, tracheostomy, re-tracheostomy, and longer decannulation time occurred more frequently in COVID-related tracheal stenosis. These events may explain the higher number of tracheal rings involved, although we cannot exclude the direct role of SARS-CoV-2 infection in the genesis of tracheal stenosis. Further studies with in vitro/in vivo models will be helpful to better understand the role of inflammatory status caused by SARS-CoV-2 in upper airways.
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
| | - Gianluca Perroni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Luca Malvezzi
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Veronica Maria Giudici
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
| | - Giorgio Maria Ferraroli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Emanuele Voulaz
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
| | - Caterina Giannitto
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Department of Diagnostic Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Fabio Acocella
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università 6, 26900 Lodi, LO, Italy
| | - Ilaria Onorati
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, 93000 Paris, France
| | - Emmanuel Martinod
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, 93000 Paris, France
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
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Monjezi M, Rismanian M, Kiani A, Abedini A, Jamaati H. Evaluation of the Tracheal Stenosis Effects on Airway Resistance and Work of Breathing Using Computational Fluid Dynamics. TANAFFOS 2023; 22:209-214. [PMID: 38628886 PMCID: PMC11016927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/01/2023] [Indexed: 04/19/2024]
Abstract
Background Bronchoscopy is one of the most accurate procedures to diagnose airway stenosis which is an invasive procedure. However, a quick and noninvasive estimation of the percent area of obstruction (%AO) of the lumen is helpful in decision-making before performing a bronchoscopy procedure. We hypothesized that there is a relationship between %AO and tracheal resistance against fluid flow. Materials and Methods By measuring airway resistance, %AO could be estimated before the procedure. Using computational fluid dynamics (CFD), this study simulates the fluid flow through trachea models with web-liked stenosis using CFD. A cylindrical segment was inserted into the trachea to represent cross-sectional areas corresponding to 20%, 40%, 60%, and 80% AO. The fluid flow and pressure distribution in these models were studied. Our CFD simulations revealed that the tracheal resistance is exponentially increased by %AO. Results The results showed a 130% and 55% increase in lung airway resistance and resistive work of breathing for an 80% AO, respectively. Moreover, a curve-fitted relationship was obtained to estimate %AO based on the measured airway resistance by body plethysmography or forced oscillation technique. Conclusion This pre-estimation is very useful in diagnostic evaluation and treatment planning in patients with tracheal stenosis.
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Affiliation(s)
- Mojdeh Monjezi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Rismanian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jamaati
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Huang CY, Chang TS, Alice Hwang L, Lin YS. Novel airway-cartilage combined model for medialization laryngoplasty and laryngotracheal reconstruction surgery planning. J Chin Med Assoc 2022; 85:1076-1082. [PMID: 35947024 DOI: 10.1097/jcma.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The clinical outcomes of surgical treatments for vocal cord paralysis and tracheal stenosis, such as medialization laryngoplasty and laryngotracheal reconstruction, vary owing to the complex anatomy and physiology of the human upper airway. However, advances in three-dimensional (3D) simulation and printing ushered its use on an office-based workstation to aid in several surgical areas. METHODS The preoperation neck computed tomography image was loaded into the InVesalius 3.0 software for manual segmentation of airway and nearby important anatomic landmarks including hyoid bone, thyroid cartilage, and cricoid cartilage. The 3D model of the desired anatomy structure was manufactured and used for presurgical planning and rehearsal of the surgery. RESULTS We review cases of four patients: two cases of unilateral vocal palsy undergoing medialization laryngoplasty and two cases of tracheal stenosis patients who used the air-cartilage combined model. CONCLUSION Preoperation planning of the medialization thyroplasty could be more precise by prevision of the paralyzed vocal cord plane. Tracheal surgery could benefit from a preoperative design of segmented length. The novel airway-cartilage combined model offers new insight into vocal cord and trachea surgery.
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Affiliation(s)
- Chien-Yu Huang
- Department of Otolaryngology, Head and Neck Surgery, Chia-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- College of Artificial Intelligence, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ting-Shou Chang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Lisa Alice Hwang
- Department of Oral and Maxillofacial Surgery, Chia-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- Department of Stomatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Yaoh-Shiang Lin
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan, ROC
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Bourdillon AT, Hajek MA, Wride M, Lee M, Lerner M, Kohli N. Correlations of Radiographic and Endoscopic Observations in Subglottic Stenosis. Ann Otol Rhinol Laryngol 2021; 131:724-729. [PMID: 34459264 DOI: 10.1177/00034894211042768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE(S) Subglottic stenosis (SGS) represents a constellation of diverse pathologic processes that ultimately lead to narrowing of the subglottic region and can produce significant morbidity. Existing endoscopic and radiographic assessments may not be consistent in practice. METHODS Severity of stenosis was evaluated and reported using the Cotton-Myer classification system from 33 endoscopic procedures from 32 unique subjects. Radiographic imaging within the preceding 3 month period was subsequently reviewed and narrowing was measured by a blinded radiologist. Degree of stenosis was reported as a percentage in 30 out of 33 endoscopic evaluations and subsequently compared to radiographically determined percentage of stenosis. Statistical analyzes were conducted to evaluate concordance between endoscopic and radiographic assessments. RESULTS About 45.5% (15/33) of the evaluations were in agreement using Cotton-Myer scoring, while 27.3% (9/33) were discrepant by 1 grade and 27.3% (9/33) by 2 grades. Correlation of degree of stenosis as a percentage using Spearman (coefficient: 0.233, P-value: .214) and Pearson (coefficient: 0.138, P-value: .466) methods demonstrated very weak relationships. Radiographic scoring did not predict endoscopic classification to a significant degree using mixed effects regression. CONCLUSIONS Radiographic and endoscopic grading of subglottic stenosis may not be reliably concordant in practice.
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Affiliation(s)
| | - Michael A Hajek
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Mitchel Wride
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Mike Lee
- Department of Radiology and Biomedical Imaging Diagnostic Radiology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Michael Lerner
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Nikita Kohli
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT, USA
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CT findings of non-neoplastic central airways diseases. Jpn J Radiol 2021; 40:107-119. [PMID: 34398372 DOI: 10.1007/s11604-021-01190-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/10/2021] [Indexed: 01/02/2023]
Abstract
Non-neoplastic lesions of central airways are uncommon entities with different etiologies, with either focal or diffuse involvement of the tracheobronchial tree. Clinical symptoms of non-neoplastic tracheobronchial diseases are non-specific, and diagnosis is difficult, especially in the early stages. Three-dimensional computed tomography (3D-CT) is an evaluable tool as it allows to assess and characterize tracheobronchial wall lesions and meanwhile it enables the evaluation of airways surrounding structures. Multiplanar reconstructions (MPR), minimum intensity projections (MinIP), and 3D Volume Rendering (VR) (in particular, virtual bronchoscopy) also provide information on the site and of the length of airway alterations. This review will be discussed about (1) primary airway disorders, such as relapsing polychondritis, tracheobronchophathia osteochondroplastica, and tracheobronchomegaly, (2) airway diseases, related to granulomatosis with polyangiitis, Chron's disease, Behcet's disease, sarcoidosis, amyloidosis, infections, intubation and transplantation, (3) tracheobronchial malacia, and (4) acute tracheobronchial injury. 3D-CT findings, especially with MPR and 3D VR reconstructions, allows us to evaluate tracheobronchial disease morphologically in detail.
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Sahin MF, Beyoglu MA, Yazicioglu A, Yekeler E. Analysis of 40 patients who underwent tracheal resection due to benign complex tracheal stenosis. Asian J Surg 2021; 45:213-219. [PMID: 34052083 DOI: 10.1016/j.asjsur.2021.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Benign tracheal stenosis is a common complication in patients followed up in intensive care units. We aimed to analyze the etiology, diagnostic approaches, treatment methods for benign tracheal stenosis, and the predicting factors for complications after tracheal resection for benign stenosis. MATERIAL-METHOD Forty patients who underwent tracheal resection reconstruction due to benign tracheal stenosis were analyzed retrospectively. Predictive factors for complications were determined by statistical analysis. RESULTS There were 23 patients (57.5%) in the intubation group, 11 patients (27.5%) in the tracheostomy group, and 6 patients (15%) in the subsequent tracheostomy group. Preoperatively, rigid dilatation was applied to all patients between 2 and 6 sessions (median = 3). Tracheal resections were performed in all patients after rigid dilatations. The mean of the resected segment lengths is 32.1 ± 8.8 mm. There was a statistically significant difference between preoperative bronchoscopic measurements, preoperative tomography measurements, and intraoperative measurements of the stenosis segment (ꭓ2 (2) = 71,500; p < 0.001). The patients' mean follow-up period was 27.4 ± 21.7 months (3-84). Mortality due to tracheal surgery and major anastomotic complications were not observed. The minor anastomotic complication rate was 12.5%, the non-anastomotic complication rate was 17.5%. The effect of resection length and surgical experience were found to be statistically significant risk factors for anastomotic complications. CONCLUSIONS Rigid dilatation does not provide significant palliation in complex stenosis. Bronchoscopic measurements give closer results than CT measurements in the preoperative estimation of resection length. The risk of anastomotic complications increases when the length of the resection increases and when the surgical experience is less.
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Affiliation(s)
- Mehmet Furkan Sahin
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Muhammet Ali Beyoglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Alkin Yazicioglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Erdal Yekeler
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
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Chen Y, Liao H, Niu Y, Ni X, Wang J. Anesthetic consideration for airway management in patient undergoing tracheal resection and reconstruction for severe postintubation tracheal stenosis: a case report. Postgrad Med 2021; 133:544-547. [PMID: 33593198 DOI: 10.1080/00325481.2021.1889849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction Severe postintubation tracheal stenosis (PITS) is a rare iatrogenic complication after endotracheal intubation.Case presentation A case of PITS in a 51-year-old male undergoing partial pericardiectomy with a principal diagnosis of tuberculous constrictive pericarditis. Within 6 hours of extubation, a second emergency intubation lasting 120 hours was performed. The patient reported exertional dyspnea 30 days after discharge. High-resolution tracheobronchial tree computed tomography with three-dimensional reconstruction revealed constriction of the tracheal lumen of more than 80% at the thyroid planar upper third of the trachea. Flexible bronchoscopy revealed a tracheal stenosis located 3-4 cm from the glottis that could not be passed prior to general anesthesia. Mechanical ventilation with a ProSeal laryngeal mask airway (PLMA) and preparation for extracorporeal circulation as a final rescue option were performed to maximize patient safety. The patient underwent a tracheal resection and reconstruction without complications.Conclusion A supraglottic airway mode may be a practical and worthwhile alternative for patients with severe PITS.
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Affiliation(s)
- Yi Chen
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Hong Liao
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yuanyuan Niu
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xinli Ni
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jianzhen Wang
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Snoap A, Varadarajan VV, Mowitz ME, Islam S, Collins WO. Airway management protocol for conjoined twins delivery. Int J Pediatr Otorhinolaryngol 2021; 140:110477. [PMID: 33243620 DOI: 10.1016/j.ijporl.2020.110477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Conjoined twin deliveries require collaborative preparation by multiple specialties for successful airway management. Literature regarding neonatal airway management after conjoined twin delivery is limited to case reports. We present a case series of conjoined twins and introduce an airway management protocol for conjoined twin delivery. METHODS The medical records of conjoined twins and their mothers at a tertiary care center were reviewed from April 2016 to December 2018. The NCBI database was queried for literature regarding preparation for neonatal airway management after conjoined twins delivery. RESULTS Five sets of conjoined twins were delivered. Of 10 neonates, all required bag valve mask ventilation. Other airway interventions included continuous positive airway pressure (7), endotracheal intubation (6), and direct laryngoscopy with telescopic video evaluation (1). No patients required ex-utero intrapartum treatment or emergent tracheostomy. A protocol for airway management is described and special considerations are discussed, including anatomic variations, equipment list, operating room staffing and layout, multidisciplinary prenatal conference, and airway imaging review. CONCLUSION Conjoined twin deliveries have significant implications for the otolaryngologist and require multidisciplinary collaboration. An airway management protocol allows for a standardized process to secure the neonatal airway and optimize patient outcomes.
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Affiliation(s)
- Adam Snoap
- University of Florida Department of Otolaryngology, 1345 Center Dr, Box #100264, Gainesville, FL, 32610, USA.
| | - Varun V Varadarajan
- The Ohio State University Department of Otolaryngology, 915 Olentangy River Road, Columbus, OH, 43212, USA
| | - Meredith E Mowitz
- University of Florida Department of Pediatrics, Division of Neonatology, 1600 Archer Rd, Gainesville, FL, 32610, USA
| | - Saleem Islam
- University of Florida Department of Surgery, Division of Pediatric Surgery, 1600 Archer Rd, Gainesville, FL, 32610, USA
| | - William O Collins
- University of Florida Department of Otolaryngology, 1345 Center Dr, Box #100264, Gainesville, FL, 32610, USA
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Alrabiah A, Almohanna S, Aljasser A, Zakzouk A, Habib SS, Almohizea M, Bukhari M, Alammar A. Utility of Spirometry Values for Evaluating Tracheal Stenosis Patients Before and After Balloon Dilation. EAR, NOSE & THROAT JOURNAL 2020; 101:NP62-NP67. [PMID: 32692288 DOI: 10.1177/0145561320936968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Tracheal stenosis is defined as a narrowing of the airway distal to the lower edge of the cricoid cartilage. It is initially diagnosed based on clinical presentation and then confirmed using direct laryngobronchoscopy. Other adjunctive diagnostic methods, including spirometry, have been proposed. This study aimed to evaluate the relationship between tracheal stenosis severity and pre- and post-balloon dilatation spirometry parameters in order to assess for significant changes in spirometry values and to evaluate for the effects of stenosis-associated factors on post-dilation spirometry values, including vertical length and grade of the stenosis, as well as the role of wound-modifying agents. METHODS This retrospective study included adults (>18 years of age) with isolated tracheal stenosis who underwent endoscopic balloon dilations at King Saud University Medical City from June 2015 to May 2019, with detailed documentation of operative findings and valid spirometry measurements pre- and post-balloon dilation. Basic demographic data and operative note details, including information about the percentage of tracheal stenosis, distance of tracheal stenosis from vocal cords, vertical length of stenotic segment, and use of wound-modifying agents (topical mitomycin C or triamcinolone injections), were extracted. RESULTS Fourteen patients with spirometry measurements obtained on 50 occasions (25 pre-balloon dilation and 25 post-balloon dilation) were included. Each 1-unit increase in the vertical length of the stenosis showed a statistically significant negative relationship (-1.47 L/s) with pre-balloon dilation peak expiratory flow (PEF; P = .034). Post-balloon dilation spirometric values showed statistically significant improvements for most variables. CONCLUSIONS The vertical length of an isolated tracheal stenosis can be predicted before surgical interventions using PEF values and may be a significant indicator of anticipated post-balloon dilation surgical success. Our study suggested that spirometry is a very useful technique for evaluating patients with tracheal stenosis due to its noninvasiveness, cost-effectiveness, with a good clinical value.
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Affiliation(s)
- Abdulaziz Alrabiah
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Department of Otolaryngology-Head & Neck Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Shahad Almohanna
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Aljasser
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulmajeed Zakzouk
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Syed Shahid Habib
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Almohizea
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Manal Bukhari
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Alammar
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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12
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Aravena C, Almeida FA, Mukhopadhyay S, Ghosh S, Lorenz RR, Murthy SC, Mehta AC. Idiopathic subglottic stenosis: a review. J Thorac Dis 2020; 12:1100-1111. [PMID: 32274178 PMCID: PMC7139051 DOI: 10.21037/jtd.2019.11.43] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Idiopathic subglottic stenosis (iSGS) is a fibrotic disease of unclear etiology that produces obstruction of the central airway in the anatomic region under the glottis. The diagnosis of this entity is difficult, usually delayed and confounded with other common respiratory diseases. No apparent etiology is identified even after a comprehensive workup that includes a complete history, physical examination, pulmonary function testing, auto-antibodies, imaging studies, and endoscopic procedures. This approach, however, helps to exclude other conditions such as granulomatosis with polyangiitis (GPA). It is also helpful to characterize the lesion and outline management strategies. Therapeutic endoscopic procedures and surgery are the most common management modalities, but medical therapy can also play a significant role in preventing or delaying recurrence. In this review, we describe the morphology, pathophysiology, clinical presentation, evaluation, management, and prognosis of iSGS.
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Affiliation(s)
- Carlos Aravena
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Respiratory Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco A Almeida
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sanjay Mukhopadhyay
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Subha Ghosh
- Department of Diagnostic Radiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert R Lorenz
- Head and Neck Institute, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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13
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Abstract
PURPOSE OF REVIEW Anesthesia for the resection and reconstruction of the tracheobronchial tree for neoplastic disease is challenging, both from surgical as well as anesthetic points of view. There are no published recommendations or guidelines addressing anesthetic and airway management dilemmas that arise during these surgical interventions. This review presents key aspects of preoperative imaging evaluation, surgical planning, as well as anesthesia and airway management during these complex cases. RECENT FINDINGS Newly published articles highlight both the surgical and anesthetic challenges encountered during tracheobronchial resections and emphasize the importance of creating specialized, high-volume centers for good patient outcomes. Of great importance is the development of a preoperative joint anesthetic-surgical plan which includes a patient-specific airway management strategy. This review presents newer and less commonly employed anesthetic management strategies which have been recently described in the literature to allow expansion of care to patients who were previously deemed too high risk for surgery. SUMMARY With advances in technology, the use of classical ventilation methods in conjunction with newer alternatives, such as extracorporeal membrane oxygenation, creates the premise for a more individualized, safer and controlled approach to tracheobronchial resections for oncologic purposes.
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14
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García-Herreros LG, Granada J, Díaz A, Santivañez JJ. Tracheal Bridge for Reconstruction of the Upper Airway in Double Tracheal Stenosis. Ann Thorac Surg 2019; 109:e195-e197. [PMID: 31557483 DOI: 10.1016/j.athoracsur.2019.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/27/2019] [Accepted: 08/07/2019] [Indexed: 11/25/2022]
Abstract
Tracheal reconstruction is a complex surgical procedure that requires a well-trained, multidisciplinary team to achieve optimal results. No reviews or case reports involving the use of a healthy tracheal bridge to achieve reconstruction after extensive tracheal resection (greater than 7 cm) are described. We present a clinical case of a patient with double tracheal stenosis secondary to prolonged intubation and tracheostomy for which a healthy, well-vascularized tracheal bridge was used to achieve a tracheal reconstruction without tension. The key point in performing this type of reconstruction is allowing a tension-free cervical and thoracic anastomosis.
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Affiliation(s)
| | - Julio Granada
- Department of Thoracic Surgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Angela Díaz
- Department of Surgery, Universidad El Bosque, Bogotá, Colombia
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15
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Gasri B, Mokline A, Gharsallah L, Mériem L, Messadi A. [Not Available]. ANNALS OF BURNS AND FIRE DISASTERS 2019; 32:122-129. [PMID: 31528152 PMCID: PMC6733212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
Tracheal stenosis remains frequent, especially in intensive care patients requiring prolonged intubation or tracheotomy. There is little data in the literature regarding this complication in burn patients. The aim of our study was to determine incidence, characteristics and risk factors of tracheal stenosis in burn patients. A retrospective study was conducted in a 20-bed burn ICU in Tunis over 7 years. It included all patients who presented tracheal stenosis confirmed by endoscopic and/or radiological exploration. Tracheal stenosis was confirmed in 15 patients with an overall incidence of 0.8% and an incidence of 3.5% in intubated patients. The mean age was 24 years, with TBSA of 28±15%. The burn was thermal in all patients. Facial burn was noted in all patients. Inhalation syndrome was observed in 12 patients. Duration of intubation was 16±12 days. Dyspnea, stridor and dysphonia were the most common symptoms. The onset of clinical signs was 30 days on average after extubation. All patients underwent bronchoscopy and/or cervico-thoracic scan for diagnosis. The average distance between the stenosis and vocal cords was 27 mm and the average degree of stenosis was 68%. The average length was 20 mm. Therapeutic management was based on: dilation in 3 cases, Montgomery tracheal T-tube insertion in 2 cases, and endoscopic laser therapy in 3 cases. Tracheal resection-anastomosis was performed in 5 patients. The evolution was favorable in 8 patients. Restenosis was observed in 2 patients. Five patients died. Inhalation injury, facial burn and prolonged intubation were recognized as risk factors that increase the likelihood of this complication.
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Affiliation(s)
- B. Gasri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - A. Mokline
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie
| | - L. Gharsallah
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie
| | - L. Mériem
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie
| | - A.A. Messadi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie
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16
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The evaluation and surgical management of post-intubation tracheal strictures at a thoracic surgery referral centre in South Africa. Afr J Thorac Crit Care Med 2018; 24. [PMID: 34541505 PMCID: PMC8432930 DOI: 10.7196/sarj.2018.v24i2.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 11/08/2022] Open
Abstract
Background The surgical treatment of tracheal stenosis following endotracheal intubation or tracheostomy is well described in the developed world. Objectives To describe our surgical experience with this pathology, and highlight the nuances of its diagnosis and management in South Africa. Methods We reviewed the clinical records and archived imaging of all patients who underwent tracheal resection and reconstruction for post-intubation tracheal stenosis between 1 July 2003 and 31 July 2014 in the Department of Cardiothoracic Surgery at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Results During the study period, 42 patients underwent tracheal resection. We evaluated the preoperative bronchoscopic characteristics of the tracheal stricture in all patients, and computed tomography (CT) was used as an adjunct in 28 (66%) patients. The stricture lengths determined by CT and intraoperative measurement were strongly correlated (r (27)=0.506, p=0.006), and the stricture lengths determined by bronchoscopy and intraoperative measurement were weakly correlated (r (41)=0.201, p=0.209). A total of 36 patients (85.7%) underwent surgery via a cervical approach and 6 (14.3%) via a right thoracotomy approach. There was no early mortality, and surgery was complicated by vocal cord palsy in 4 cases, restenosis in 2 cases, infection in 1 case and paraparesis in 1 case. Conclusion Tracheal resection for the treatment of post-intubation tracheal stenosis can be undertaken safely with minimal complications in the developing world, with the vast majority of lesions approached via a cervical approach. A preoperative evaluation of the stricture using CT is an accurate technique for planning tracheal resection and reconstruction.
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17
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Advanced Technologies for Imaging and Visualization of the Tracheobronchial Tree. Thorac Surg Clin 2018; 28:127-137. [DOI: 10.1016/j.thorsurg.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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18
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Vallés J, Millán S, Díaz E, Castanyer E, Gallardo X, Martín-Loeches I, Andreu M, Prenafeta M, Saludes P, Lema J, Batlle M, Bacelar N, Artigas A. Incidence of airway complications in patients using endotracheal tubes with continuous aspiration of subglottic secretions. Ann Intensive Care 2017; 7:109. [PMID: 29098448 PMCID: PMC5668230 DOI: 10.1186/s13613-017-0331-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 10/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuous aspiration of subglottic secretions is effective in preventing ventilator-associated pneumonia, but it involves a risk of mucosal damage. The main objective of our study was to determine the incidence of airway complications related to continuous aspiration of subglottic secretions. METHODS In consecutive adult patients with continuous aspiration of subglottic secretions, we prospectively recorded clinical airway complications during the period after extubation. A multidetector computed tomography of the neck was performed during the period of 5 days following extubation to classify subglottic and tracheal lesions as mucosal thickening, cartilage thickening or deep ulceration. RESULTS In the 86 patients included in the study, 6 (6.9%) had transient dyspnea, 7 (8.1%) had upper airway obstruction and 18 (20.9%) had dysphonia at extubation. Univariate analysis identified more attempts required for intubation (2.3 ± 1.1 vs. 1.2 ± 0.5; p = 0.001), difficult intubation (71.4 vs. 10.1%, p = 0.001) and Cormack score III-IV (71.4 vs. 8.8%; p < 0.001) as risk factors for having an upper airway obstruction at extubation. The incidence of failed extubation among patients after planned extubation was 18.9% and 11 patients (12.7%) required tracheostomy. A multidetector computed tomography was performed in 37 patients following extubation, and injuries were observed in 9 patients (24.3%) and classified as tracheal injuries in 2 patients (1 cartilage thickening and 1 mild stenosis with cartilage thickening) and as subglottic mucosal thickenings in 7 patients. CONCLUSIONS The incidence of upper airway obstruction after extubation in patients with continuous aspiration of subglottic secretions was 8.1%, and the injuries observed by computed tomography were not severe and located mostly in subglottic space.
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Affiliation(s)
- Jordi Vallés
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain. .,Universitat Autonoma Barcelona, Sabadell, Spain. .,CIBERES Enfermedades Respiratorias, Valladolid, Spain.
| | - Susana Millán
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain
| | - Emili Díaz
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain.,CIBERES Enfermedades Respiratorias, Valladolid, Spain
| | - Eva Castanyer
- UDIAT, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Ignacio Martín-Loeches
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain.,CIBERES Enfermedades Respiratorias, Valladolid, Spain
| | - Marta Andreu
- UDIAT, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Paula Saludes
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain
| | - Jorge Lema
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain
| | - Montse Batlle
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain
| | - Néstor Bacelar
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain
| | - Antoni Artigas
- Critical Care Department, Hospital-Sabadell, Corporació Sanitària Universitària Parc Taulí, ParcTauli s/n, 08208, Sabadell, Spain.,Universitat Autonoma Barcelona, Sabadell, Spain.,CIBERES Enfermedades Respiratorias, Valladolid, Spain
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19
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Ahuja S, Cohen B, Hinkelbein J, Diemunsch P, Ruetzler K. Practical anesthetic considerations in patients undergoing tracheobronchial surgeries: a clinical review of current literature. J Thorac Dis 2016; 8:3431-3441. [PMID: 28066624 DOI: 10.21037/jtd.2016.11.57] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tracheobronchial surgeries require close cooperation and extensive communication between the anesthesia providers and the surgeons. Anesthetic management of tracheal and bronchial pathologies differ basically from regular upper airways management, due access to the patients airway is limited, mostly even practically impossible for the anesthesia providers. As a consequence, the surgeon overtakes responsibility for the airway access from the anesthesia provider in the variety of the cases. Preoperative recognition of a difficult airway, detailed planning and being aware of plan B and plan C are the elementary keys to success. Providers have to be aware, that preoperative airway assessment does not always correlate with the ease of oxygenation and ventilation. Therefore, various methods have been described in the literature and several authors have adopted unique ways to manage the airways in a successful manner. With the advancement of surgical techniques over the years, anesthetic management has also evolved tremendously to match the needs. The commonly encountered conditions requiring surgical interventions include post-intubation stenosis and foreign body aspiration. In this review we will discuss the most common pathologies of tracheobronchial lesions and specific anesthetic management considerations related to them.
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Affiliation(s)
- Sanchit Ahuja
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Barak Cohen
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jochen Hinkelbein
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany
| | - Pierre Diemunsch
- Department of Anaesthesia and Intensive Care Medicine, University Hospitals of Hautepierre, Strasburg, France
| | - Kurt Ruetzler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA;; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
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20
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Ozkul Y, Songu M, Ozturkcan S, Imre A, Erdogan N, Ates D, Ozkul Z. Is T-tube treatment effective in Meyer-Cotton grade 3 tracheal stenosis: long-term outcomes. Acta Otolaryngol 2016; 136:933-6. [PMID: 27092981 DOI: 10.3109/00016489.2016.1170877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To present retrospective experience in Meyer-Cotton grade 3 tracheal stenosis of 17 patients treated by T-tube, considering the characteristics of the treated stenosis, surgical procedures performed, and post-operative outcomes and complications. METHODS All demographic and clinical data were collected retrospectively. Chest and neck computed tomography scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Meyer and Cotton grading scale. RESULTS The aetiology of the tracheal stenosis was intubation-related in all cases. The duration of intubation ranged between 1 hour to 40 days. According to the Myers-Cotton classification, all patients were at stage 3. Mean length of the stenosis was 26.58 ± 12.02 (range =15-70) mm. Mean follow-up for the study group was 60.16 ± 34.10 (range =18-137) months. Two patients died during follow-up, one due to stroke, one due to chronic lymphocytic leukemia; no deaths were attributable to TS. The remaining 15 patients could be evaluated up to the present time. Post-operative decannulation was achieved in three of 15 patients (20%), and decannulation was not achieved in 12 of 15 patients (80%). CONCLUSION T-tube is not an effective treatment of tracheal stenosis.
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Affiliation(s)
- Yilmaz Ozkul
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Murat Songu
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Sedat Ozturkcan
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Abdulkadir Imre
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Nezahat Erdogan
- b Department of Radiology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Duzgun Ates
- a Department of Otorhinolaryngology , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
| | - Zelal Ozkul
- c Department of Anaesthesia and Reanimation , Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir , Turkey
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22
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Ozkul Y, Songu M, Imre A, Ates D, Arslanoglu S, Pinar E, Onal K. CO₂ laser treatment of tracheal stenosis. Acta Otolaryngol 2015; 135:1160-2. [PMID: 26137899 DOI: 10.3109/00016489.2015.1063687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Delivery of a carbon dioxide laser is an effective method and can be used in selected cases of tracheal stenosis. OBJECTIVES To present retrospective experience in tracheal stenosis of 16 patients treated by bronchoscopic delivery of carbon dioxide laser, considering the characteristics of the treated stenosis, surgical procedures performed, and post-operative outcomes and complications. METHODS All demographic and clinical data were collected retrospectively. Chest and neck computed tomography scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Meyer and Cotton grading scale. RESULTS The aetiology of the tracheal stenosis was intubation-related in 14 cases, and idiopathic in two cases. The duration of intubation ranged between 1 hour to 26 days. According to the Myers-Cotton classification, mean stage of stenosis for the study group was 3.3 ± 0.5. Mean length of the stenosis was 23.75 ± 6.95 (range = 15-40) mm. Mean follow-up for the study group was 23.81 ± 7.11 (range = 12-38) months. Postoperative decannulation was achieved in 13 patients (81.3%), and decannulation was not achieved in three patients (18.7%).
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Affiliation(s)
- Yilmaz Ozkul
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Murat Songu
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Abdulkadir Imre
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Duzgun Ates
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Secil Arslanoglu
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Ercan Pinar
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
| | - Kazim Onal
- a Department of Otorhinolaryngology, Izmir Katip Celebi University, Ataturk Training and Research Hospital , Izmir, Turkey
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Bacon JL, Patterson CM, Madden BP. Indications and interventional options for non-resectable tracheal stenosis. J Thorac Dis 2014; 6:258-70. [PMID: 24624290 DOI: 10.3978/j.issn.2072-1439.2013.11.08] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 11/20/2013] [Indexed: 12/12/2022]
Abstract
Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable tracheal stenosis can be successfully managed by interventional bronchoscopy, with therapeutic options including airway dilatation, local tissue destruction and airway stenting. There are common aspects to the management of tracheal obstruction, tracheomalacia and tracheal fistulae. This paper reviews the pathogenesis, presentation, investigation and management of tracheal disease, with a focus on tracheal obstruction and the role of endotracheal intervention in management.
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24
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Rubikas R, Matukaitytė I, Jelisiejevas JJ, Račkauskas M. Surgical treatment of non-malignant laryngotracheal stenosis. Eur Arch Otorhinolaryngol 2014; 271:2481-7. [PMID: 24652116 DOI: 10.1007/s00405-014-2981-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/21/2014] [Indexed: 11/25/2022]
Abstract
The objectives of this study were the following: (1) to analyze the results of surgical treatment of non-malignant subglottic laryngeal and tracheal stenosis, (2) to evaluate the feasibility and technical aspects of the video mediastinoscopy for the mobilization of the mediastinal trachea, (3) to evaluate the influence of the early internal condition of the anastomosis on the development of restenosis. From 1996 up to 2013, 75 patients aged 11-78 years underwent surgery for post-intubation/tracheostomy (71 patients), post-traumatic (3 patients), and idiopathic (1 patient) subglottic laryngeal and tracheal stenosis. Twenty-three (30.7 %) patients with subglottic laryngeal and upper tracheal stenosis underwent cricotracheal resection and thyrotracheal anastomosis (group A), while 52 (69.3 %) patients with tracheal stenosis underwent tracheal resection and cricotracheal or tracheotracheal anastomosis (group B). The length of the resected segment in patients of groups A and B was 28-55 (42 ± 11) mm and 18-65 (36 ± 14) mm, respectively, (p = 0.22). Perioperative complications within 30 days occurred in eight (34.8 %) patients of group A, and in six (11.5 %) patients of group B (p = 0.04). There was one intraoperative and one postoperative death on the third day due to heart failure. The excellent results were achieved in 63 (86.3 %), satisfactory in 8 (11.0 %), and unsatisfactory in 2 (2.7 %) patients. The incidence rate of perioperative complications is related to the location of the stenosis and the type of the resection and anastomosis. Video mediastinoscopy simplifies the mobilization of the mediastinal trachea, which allows for carrying out the anastomosis with minimal tension. Early internal abnormalities of the anastomosis predict its restenosis.
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Affiliation(s)
- Romaldas Rubikas
- Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian Health Sciences University , Eivenių 2, 5009, Kaunas, Lithuania,
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Jamaati HR, Shadmehr MB, Aloosh O, Radmand G, Mohajerani SA, Hashemian SM. Evaluation of plethysmography for diagnosis of postintubation tracheal stenosis. Asian Cardiovasc Thorac Ann 2014; 21:181-6. [PMID: 24532617 DOI: 10.1177/0218492312454537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Post-intubation tracheal stenosis is a serious disease caused by cuff pressure during tracheal intubation. The reported prevalence of post-intubation tracheal stenosis is 10%-22% in intubated patients. Invasive diagnostic methods based on fiberoptic or rigid bronchoscopy are suggested for initial assessment and treatment. This study aimed to evaluate plethysmography as an alternative diagnostic tool for post-intubation tracheal stenosis. We also assessed the relationship between plethysmography and bronchoscopy findings in patients with post-intubation tracheal stenosis. METHODS The sample included 30 patients who were admitted to our intensive care unit or surgical ward during the course of a year, and diagnosed with post-intubation tracheal stenosis. All patients underwent plethysmography and rigid bronchoscopy. The relationship between the plethysmography and bronchoscopy findings was examined. RESULTS Stricture intensity had the strongest correlation with upper airway resistance (p = 0.001). The relationship of length of stricture to forced expiratory volume in 1 s and maximum expiratory flow 50 and 75 was significant in univariate analysis, and to reserve volume and total lung capacity in multivariate analysis. CONCLUSION Significant relationships were found between plethysmography variables and rigid bronchoscopy findings in patients with post-intubation tracheal stenosis, and some formulas were developed to give an alternative estimate of stricture severity, without bronchoscopy.
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Affiliation(s)
- Hamid Reza Jamaati
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Shweel M, Shaban Y. Radiological evaluation of post-traumatic tracheal stenosis using multidetector CT with multiplanar reformatted imaging and virtual bronchoscopy: Comparison with intraoperative findings. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Laryngotracheal reconstruction with autogenous rib cartilage graft for complex laryngotracheal stenosis and/or anterior neck defect. Eur Arch Otorhinolaryngol 2013; 271:317-22. [DOI: 10.1007/s00405-012-2256-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 11/01/2012] [Indexed: 10/26/2022]
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Virtual bronchoscopy in the era of multi-detector computed tomography: Is there any reality? Med J Armed Forces India 2013; 69:305-10. [PMID: 24600130 DOI: 10.1016/j.mjafi.2012.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 12/05/2012] [Indexed: 11/22/2022] Open
Abstract
Virtual bronchoscopy, in conjunction with axial and MPR MDCT images, can enhance diagnostic accuracy of tracheo-bronchial endoluminal pathologies. We describe a few cases highlighting the utility of virtual bronchoscopy in the diagnosis of varied tracheo-bronchial pathologies encountered in the setting of a tertiary care Armed Forces Hospital of India.
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Negm H, Mosleh M, Fathy H. Circumferential tracheal resection with primary anastomosis for post-intubation tracheal stenosis: study of 24 cases. Eur Arch Otorhinolaryngol 2013; 270:2709-17. [PMID: 23397061 DOI: 10.1007/s00405-013-2367-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 01/15/2013] [Indexed: 11/27/2022]
Abstract
The objective of this study is to evaluate the results of circumferential tracheal and cricotracheal resection with primary anastomosis for the treatment of post-intubation tracheal and cricotracheal stenosis. This is a retrospective analytical study. A total number of 24 patients were included in this study. The relevant preoperative, operative and postoperative records were collected and analyzed. Twenty patients were finally symptom-free reflecting an anastomosis success rate of 83.3 %. Variable grades of anastomotic restenosis occurred in 11 (45.8 %) patients, three patients were symptom-free and eight had airway obstructive symptoms. Four out of the eight patients with symptomatic restenosis were symptom-free with endoscopic dilatation while the remaining four patients required a permanent airway appliance (T-tube, tracheostomy) for the relief of airway obstruction and this group was considered as anastomotic failure. Cricoid involvement, associated cricoid resection and the type of anastomosis were the variables that had statistical impact on the occurrence of restenosis (P = 0.017, 0.017, 0.05; respectively). Tracheal resection with primary anastomosis is a safe effective treatment method for post-intubation tracheal stenosis in carefully selected patients. Restenosis does not always mean failure of the procedure since it may be successfully managed with endoscopic dilatation.
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Affiliation(s)
- Hesham Negm
- Depatment of Otolaryngology Head and Neck Surgery, Kasr ElAini University Hospital, Cairo University, Cairo, Egypt.
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Mizutani L, Yazawa K, Komatsu Y. Multidetector CT evaluation for the diagnosis of tracheal stenosis occurring shortly after intubation. BMJ Case Rep 2012; 2012:bcr-2012-007591. [PMID: 23239774 DOI: 10.1136/bcr-2012-007591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Lisa Mizutani
- Trauma and Critical Care Center, Suwa Red Cross Hospital, Suwa City, Nagano, Japan
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