Airway management during unusual tracheal stenosis:A clinical feasibility trial

Altun Bingöl D., Canbaz M., Altun D., Sen C., Çamcı A. E.

Laryngoscope investigative otolaryngology, cilt.0, sa.0, ss.1-9, 2023 (SCI-Expanded)

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 0 Sayı: 0
  • Basım Tarihi: 2023
  • Doi Numarası: 10.1002/lio2.1151
  • Dergi Adı: Laryngoscope investigative otolaryngology
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED)
  • Sayfa Sayıları: ss.1-9
  • Acıbadem Mehmet Ali Aydınlar Üniversitesi Adresli: Evet

Özet

Objectives:Prolonged intubation is a known risk factor of LTS. LTS related to COVID-19may result in a different phenotype: pronation affects the location of stenosis andCOVID-19 pneumonia can decline lung mechanics. Therefore, airway management inthese patients may carry unique challenges for both anesthesiologists and surgeons.This prospective observational feasibility trial aims to evaluate the use of a novel thin,cuffed, endotracheal tube (Tritube) in combination with flow-controlled ventilation (FCV)in the management of patients with COVID-19-related LTS undergoing laryngeal surgery.Methods:20 patients suffering from COVID-19-related LTS, as diagnosed by CT,requiring endolaryngeal surgery, with or without CO2laser, were included. Ultrathinendotracheal tube Tritube, together with FCV was used for airway management andventilation. Feasibility, ventilation efficiency, and surgical exposure were evaluated.Results:Median duration of mechanical ventilation during their ICU stay was17 days, (range, 7–27), and all patients had been pronated. In 18/20 patients, endo-scopic diagnosis confirmed the initial CT diagnosis: posterior subglottic stenosis. Sur-geons’satisfaction on the view was rated 9 out of 10 (range 7–10), where 0 was theworst view and 10 was the best view. Hemodynamic and respiratory variables werewithin the normal clinical range during the surgical procedure. One patient that had aSpO2 of 90% before induction of anesthesia, a temporal drop to 89%, caused meet-ing the predefined requirement of“respiratory complication.”Conclusion:This study demonstrates the feasibility of using Tritube with FCV inpatients with relatively unusual subglottic posterior location tracheal stenosis, undergo-ing laryngotracheal surgery. Tritube provides a good surgical field and FCV provideshighly adequate ventilation especially in patients with compromised lung mechanics.Level of Evidence:IV, non-comparitive prospective clinical trial with 20 patients