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Hosna A, Haseeb Ul Rasool M, Noff NC, Makhoul K, Miller D, Umar Z, Ghallab M, Hasan R, Ashfaq S, Parikh A, Lopez R. Cryotherapy for the Treatment of Tracheal Stenosis: A Systematic Review. Cureus 2023; 15:e41012. [PMID: 37519508 PMCID: PMC10372464 DOI: 10.7759/cureus.41012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Tracheal stenosis (TS) is an iatrogenic sequela after intubation or tracheostomy that is increasing despite technological improvement and skilled respiratory care in the ICU. According to the studies, the rate of TS varies from 10 to 22%, but only 1-2% of these stenoses are severe and present with inspiratory dyspnea that does not respond to medical management. Bronchoscopy is considered the most appropriate diagnostic test, and laser surgery and tracheobronchial stenting are the most commonly performed procedures for tracheal stenosis. However, alternative treatment options, including cryotherapy for inoperable patients, have yet to be studied widely. As the number of patients requiring ICU admission with mechanical intubation is increasing, it is crucial to acknowledge this complication and consider alternative management options. Here we present a review of the use of cryotherapy for post-intubation tracheal stenosis. Pubmed, Cochrane, and EMBASE databases were inquired for studies performed using the keywords 'airway stricture' OR 'airway obstruction' AND 'post-intubation' OR 'post-extubation' OR 'tracheostomy' AND 'cryotherapy'. After the primary and secondary screening, five studies were included in the analysis. We included 67 patients were included in the analysis, with a mean age of 50.2 (range: 42-55) years. Tracheal stenosis and subglottic stricture were the most common sites of stenosis. Twenty-nine patients were treated with cryotherapy only, while the rest 38 patients had cryotherapy followed by balloon dilation. After the intervention, 48 patients experienced improvement, five experienced no change in the symptoms, 13 patients were asymptomatic before the treatment, and one died. No complication was reported in 65 patients, with only minor complications reported in rest. Although, there is no clear treatment protocol for patients with inoperable tracheal stenosis. Our review demonstrates that cryotherapy for inoperable tracheal stenosis can be an acceptable alternative treatment with significant clinical improvement. Additionally, cryotherapy has fewer adverse effects compared to other treatment options.
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Affiliation(s)
- Asma Hosna
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | | | - Nicole C Noff
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | | | - Daniel Miller
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | - Zaryab Umar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | - Muhammad Ghallab
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals, New York City, USA
| | - Rockyb Hasan
- Internal Medicine, Texas Tech University Health Sciences Center - Amarillo Campus, Lubbock, USA
| | - Salman Ashfaq
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Avish Parikh
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
| | - Ricardo Lopez
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
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Beyoglu MA, Sahin MF, Turkkan S, Yazicioglu A, Yekeler E. Complex Post-intubation Tracheal Stenosis in Covid-19 Patients. Indian J Surg 2022; 84:805-813. [PMID: 35818393 PMCID: PMC9261125 DOI: 10.1007/s12262-022-03498-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
Management of tracheal complications due to endotracheal intubation in patients with coronavirus disease-2019 (COVID-19) is an important concern. This study aimed to present the results of patients who had undergone tracheal resection and reconstruction due to COVID-19-related complex post-intubation tracheal stenosis (PITS). We evaluated 15 patients who underwent tracheal resection and reconstruction due to complex PITS between March 2020 and April 2021 in a single center. Seven patients (46.6%) who underwent endotracheal intubation due to the COVID-19 constituted the COVID-19 group, and the remaining 8 patients (53.4%) constituted the non-COVID-19 group. We analyzed the patients’ presenting symptoms, time to onset of symptoms, radiological and bronchoscopic features of stenosis, bronchoscopic intervention history, length of the resected tracheal segment, postoperative complications, length of hospital stay, and duration of follow-up. Six of the patients (40%) were female, and 9 (60%) were male. Mean age was 43.3 ± 20.5. We found no statistically significant difference between the COVID-19 and non-COVID-19 PITS groups in terms of presenting symptoms, time to onset of symptoms, stenosis location, stenosis severity, length of the stenotic segment, number of bronchoscopic dilatation sessions, dilatation time intervals, length of the resected tracheal segment, postoperative complications, and length of postoperative hospital stay. Endotracheal intubation duration was longer in the COVID-19 group than non-COVID-19 group (mean ± SD: 21.0 ± 4.04, 12.0 ± 1.15 days, respectively). Tracheal resection and reconstruction can be performed safely and successfully in COVID-19 patients with complex PITS. Comprehensive preoperative examination, appropriate selection of surgery technique, and close postoperative follow-up have favorable results.
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Affiliation(s)
- Muhammet Ali Beyoglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, MH2 Binasi, B1 Kati, E2 Bolumu, Universiteler Mahallesi 1604, Cadde No: 9, Çankaya, Ankara, Turkey
| | - Mehmet Furkan Sahin
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, MH2 Binasi, B1 Kati, E2 Bolumu, Universiteler Mahallesi 1604, Cadde No: 9, Çankaya, Ankara, Turkey
| | - Sinan Turkkan
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, MH2 Binasi, B1 Kati, E2 Bolumu, Universiteler Mahallesi 1604, Cadde No: 9, Çankaya, Ankara, Turkey
| | - Alkin Yazicioglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, MH2 Binasi, B1 Kati, E2 Bolumu, Universiteler Mahallesi 1604, Cadde No: 9, Çankaya, Ankara, Turkey
| | - Erdal Yekeler
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, MH2 Binasi, B1 Kati, E2 Bolumu, Universiteler Mahallesi 1604, Cadde No: 9, Çankaya, Ankara, Turkey
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