Post-intubation tracheal stenosis after management of complicated aortic dissection: a case series
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Post-intubation tracheal stenosis after management of complicated aortic dissection: a case series Jia Liu1, Chun-Peng Zhang2, Ye Li3 and Su Dong4*
Abstract Background: Patients undergoing total aortic arch replacement or aortic dissecting aneurysmectomy are generally managed with medications to control hypotension and blood coagulation to minimize mortality and morbidity. However, prolonged mechanical ventilation via tracheal intubation increases the risk of tracheal stenosis in such patients. Case presentation: We present 2 cases (a 49-year-old woman and a 62-year-old man) of post-intubation tracheal stenosis occurring after surgery for the correction of complicated aortic dissection; both cases were successfully managed by tracheal cryotherapy. Conclusion: Continuous monitoring of cuff pressure and regular cuff palpation are necessary to minimize the incidence of tracheal stenosis. If the patients have concomitant local or systemic infection, adequate preventive measures should be taken to reduce the incidence of post-intubation tracheal stenosis. Tracheal cryotherapy is recommendable for the management of post-intubation tracheal stenosis. Keywords: Tracheal intubation, Tracheal stenosis, Aortic dissection
Background Total aortic arch replacement and aortic aneurysmectomy are frequently performed at large medical centers for the management of patients with acute aortic dissection. Generally, patients with complicated aortic arch lesions also have systemic vascular comorbidities. Patients undergoing total aortic arch replacement or aortic aneurysmectomy require special care for the intraoperative management of blood pressure and blood coagulation during the surgery in order to minimize morbidity and mortality associated with the procedure; however, prolonged mechanical ventilation during tracheal intubation increases the risk of tracheal stenosis [1, 2]. However, reports on the management of tracheal stenosis in patients undergoing surgery for aortic arch disease are limited. In this paper, we present two cases of tracheal stenosis caused by prolonged mechanical ventilation in
* Correspondence: [email protected] 4 Department of Anesthesia, First hospital of Jilin University, No.71st Xinmin ST, Changchun, Jilin 130021, China Full list of author information is available at the end of the article
patients who underwent surgery for the treatment of complicated aortic dissection. Case presentation Case 1
The patient was a 49-year-old woman presenting to the emergency department of our institution with severe chest pain; the patient was diagnosed with acute aortic dissection (Standford type A) and referred to the Department of Cardiovascular Surgery. Twenty-four hours after the referral, the patient underwent emergent total aortic arch replacement and distal repair with the stented elephant trunk procedure. After the procedure, the patient was transferred to the intensive care unit for the further management of mechanical ventilation. To prevent postoperative bleeding, the arterial bloo
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