Postintubation tracheal stenosis – A 15 year experience

Background: Postintubation injury, with or without tracheostomy, is the most common cause of benign tracheal stenosis (TS). Aim: To analyse characteristics, management and follow-up of postintubation TS. Methods: Retrospective analysis of patients with postintubation TS evaluated at department of Broncology in Hospital de São João between 1st January 1996 and 31st December 2010. Results: 84 patients were analyzed, with a mean age of 43.5 years. Median duration of intubation was 23 days and 38% of patients had a tracheostomy. Among tracheostomized patients, median time of orotracheal intubation before tracheostomy was 29 days. Symptoms occurred in a median of 30 days after extubation. Occurrence of stridor was associated to an earlier diagnosis. TS occurred at a high location (subglottis or upper tracheal third) in 82.9% of patients and was mostly complex (55.1%), followed by exophitic and web-like (14.5%). In children, web-like stenosis was predominant. Occurrence of ventilator-associated pneumonia was associated to complex TS and higher levels of severity. Endoscopic treatment was the first therapeutic measure in most patients (84.8%). Dilation was the main therapeutic option, either isolated (39%), either as a bridge to more definitive therapies (54.2%), and even after failure of other therapies (16.9%). Patients treated only with dilation performed a mean of 2 dilations/patient and median free time between dilations was 47 days. Surgical treatment was performed in 42.1%, with 38.7% of relapse. 13.2% of patients had stent placement and 11.8% had laser therapy. Most patients are now assymptomatic and mean residual stenosis is 28%. Conclusion: TS is a challenging condition and several therapeutic modalities are usually needed.